Penicillin Allergy and Superbugs

  Penicillin allergy is a common finding in many patient charts.  Sometimes it can be difficult to figure out who, when and why this label was added to a medical record.  Sometimes patients themselves perpetuate the label, unwittingly reporting something a parent told them about a possible reaction as a child, or mistaking side effectsRead more

Probiotics. Use them. Love them.

We all prescribe antibiotics frequently.  While the debate about who is contributing more to the terrifying antibiotic resistance patterns and the emergence of superbugs rages on, we can sometimes forget or minimize the fact that antibiotics have immediate side effects for our patients.  Serious and seriously unpleasant side effects.   A publication in JAMA fromRead more

Doc, I have this burning sensation…

  For many of our patients, frequent UTIs can be a big source of discomfort and frequent ED or PMD visits.  Women, in particular, are impacted by this issue as they have >50% lifetime risk of acute cystitis.  Many are treated with antibiotics which may or may not be appropriate (don’t worry, that is aRead more

Santa is Real. Here’s Proof.

Just kidding.  Happy Holidays, kids.   Follow Santa on his magical trek around the world:   Bonus: Want to know more about the Dreidel? more

Lidocaine drip, but not what you think

The practice of using EMLA or LET cream on a wound that is about to be cleansed, explored and sutured is common, especially in the PEDs world.  However, both of these options take time to work, which can be a significant barrier to use during a busy shift. A paper published in October 2018 (seeRead more

Concussion Recovery in Children

An otherwise healthy 11 year old boy is brought to the ED by his parent after “hitting his head pretty hard” during hockey practice.  The child was “out of it” for a little while but did not lose consciousness.  He seems foggy, complains of a headache and asks to turn off the lights.  You diagnoseRead more

Doc, what if my head explodes?

It’s a busy Monday afternoon.  Patients are packed into the department like sardines.  You have bruises on your shins from trying to wade through the stretchers to discharge a few people, but now you’re back at the computer ready to pick up some new ones.  You click on the next person waiting to be seen,Read more

Zombie foot in need of repair

Imagine your patient is minding his or her own business when their foot gets crushed by a bus.  This totally hypothetical occurrence is only one of an infinite number of examples of situations that could result in a complex wound(s) needing repair. For wounds on the soles of the feet, adequate anesthesia via local infiltrationRead more

Line ’em up like a boss

Patients in need of need central lines can often have less than ideal IVC diameters, either because of their disease process or because of their baseline anatomy.  Optimizing your chances of success through positioning can make a real difference for both you and your patients.   Ideally, placing your patient in Trendelenberg position or askingRead more

Does roc rock and suc suck?

A study just published this month in Annals of Emergency Medicine compared the 2 most common paralytics we use in the ED for RSI, rocuronium and succinylcholine. The primary outcome studied was first pass success rate, and the secondary outcome was adverse effects including cardiac arrest, hypotension, dental trauma, and dysrhythmias. While succinylcholine used to beRead more