Blog

Easier Subclavian Access

We don’t often put in subclavian TLCs in the ED because of the increased risk of complications, specifically pneumothorax. Often, it’s difficult to do with US guidance so we turn to placing IJ TLCs instead. However, there are certain patients who might require a subclavian line and in those, anything that makes the subclavian moreRead more

52 in 52: The Rivers Trial

Title: “The 52 in 52 Review: Early goal-directed therapy in the treatment of severe sepsis and septic shock” Article Citation: Rivers E, Nguyen B, Havstad S, Ressler J, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. PMID:Read more

Ketamine for acute pain in the ED

Deaths from heroin rose to 8,260 in 2013, quadrupling since 2000 and aggravating what some were already calling the worst drug overdose epidemic in United States history. Overall, drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day. We’re aware that the opioidRead more

Sphenopalantine Ganglion Block for Migraines

Patients presenting to the ED with migraine pain can often present a challenge in terms of pain control. For patients who have pain refractory to NSAIDs, IV fluids, and migraine abortive therapies, or those who would prefer not to receive an IV, what other options can we turn to? The sphenopalatine ganglion (SPG) plays aRead more

Absolute Lymphocyte Count as a Predictor of CD4

An HIV positive patient presents to the ED but doesn’t know his CD4 count. He hasn’t been taking his HAART and you’re rightfully concerned that he might be susceptible to opportunistic infections. Unfortunately, you can’t find any information about how immunosuppressed he is. Is there a way to estimate his CD4 count? Luckily, there is!Read more

Determining Capacity

A 74 year old female with a GI bleed is refusing treatment, stating that she just wants to go home rather than being transfused for her hemoglobin is 5. You attempt to convince her to stay but she steadfastly says that she just wants to leave. She mentions she has to feed her dog andRead more

Globe Subluxation

Apologies for the lack of recent pearls. Now that the website is back up and running, we’ll be going back to our regularly scheduled programming. “Hey doc, my eyeball popped out”. It’s a chief complaint that we don’t hear too often in the ED but when it happens, it’s enough to make me sweat aRead more

Ticked off

Today’s TR pearl is brought to you by Drs. Shearer, Hernandez, Sun and O’Halloran and summer in the Northeast. The weather is warm and people are flocking to the great outdoors. This means…ticks, as well as the tick borne diseases they may carry. For how to remove a tick, see Dr. Paulis’s excellent clinical pearlRead more

52 in 52: A Clinical Predictive Tool for Intra-Abdominal Trauma in Pediatric Patients

Title: Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma Article Citation: Holmes JF, Mao A, Awasthi S, McGahan JP, et al. Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med. 2009 Oct;54(4):528-33. PMID: 19250706 WhatRead more

Burn Baby Burn

Happy 4th of July! I’m taking the day to review a commonly incurred injury on the holiday: burns. Whether it’s from operating a grill after a few too many libations or an unfortunate encounter with fireworks, the incidence of burns seems to go up dramatically on the 4th. While we mostly see minor burns inRead more