Subarachnoid Hemorrhage Revisited

Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency department. The thought of potentially missing a sentinel bleed from an aneurysm or AVM is something that keepsRead more

Choosing the Best Test

Today’s pearl is short and sweet. Here’s a breakdown of common radiologic studies performed in the emergency department along with their sensitivities and specificities according to the available literature. You may be surprised by some of the findings and lack of evidence for commonly obtained studies. Study Sensitivity/Specificity (%) Plain Film Sensitivity/Specificity (%) CT Sensitivity/SpecificityRead more

To Buffer an Acid You Add a Base, Right?

What do you do if your septic patient now has a lactate of 12 and a pH of 7.00? You’ve already started your fluids, antibiotics, pressors, and have ruled out any unaddressed source. Intuitively, your patient’s acidosis should be corrected by providing a base – specifically sodium bicarbonate. This is a common approach, although asRead more

Doing Away with Dopamine for Pediatric Septic Shock

The current Surviving Sepsis Campaign guidelines recommend starting either dopamine up to 10mcg/kg/min or epinephrine 0.05 mcg/kg/min for pediatric patients suffering from fluid-refractory septic shock. There is a significant lack of evidence as to which of the two agents is most beneficial, however, until a recent study published in Critical Care Medicine attempted to addressRead more

A Modified Valsalva for Svt

Although clinical practice may differ, vagal maneuvers are still the first step in attempting to convert supraventricular tachycardia (SVT) to sinus rhythm prior to adenosine. The reason why they are rarely attempted is because of relatively low (5-20%) success rates. A recent study published in The Lancet describes a method of Valsalva maneuver which has improvedRead more

Arytenoid Cartilage Dislocation

Your patient with respiratory failure was successfully intubated and admitted to the MICU. Two weeks later he comes back to the ED complaining of persistent hoarse voice and dysphagia. He states he was extubated 1 week prior and was told his symptoms would resolve but they hadn’t. What could be going on?Read more

Serum Sickness

Serum sickness is an often overlooked entity when considering the differential diagnosis of a febrile patient. This is a brief overview on the history and management of a patient who presents with signs and symptoms of this disorder:Read more

We’ve Got a Pumper Here!

Hemostasis is an essential step in wound management. Most commonly, bleeding is caused by lacerated subdermal plexus and superficial veins which can be controlled with pressure alone. When lacerations are especially deep, an artery may also be affected. In these situations, special maneuvers are often necessary to obtain adequate hemostasis.Read more

Is It Time to End Routine C-spine Immobilization?

  Cervical spine immobilization is a routine precaution taken by both EMS and Emergency Departments for patient who experience oftentimes minimal trauma. The purpose of maintaining immobilization of the cervical spine with suspected bony injury is to prevent secondary injury.  Other than patient discomfort, maintaining cervical spine immobilization is oftentimes resource-heavy and can complicate essentialRead more

Did the Patient Finish Their Oral Contrast?

  CT scans are cited as a frequent source of delay to disposition of our patients in the emergency department. A contributing factor to this delay is the time it takes one to drink their oral contrast and to allow this contrast to travel throughout the intestines. The truth is, very few people actually needRead more