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Edible Arrangements: What You Need to Know About Edible Marijuana

In recent years, a number of states have decriminalized marijuana for medical use, and some have even decriminalized recreational use. This trend is likely to continue. Much of this marijuana – particularly when used recreationally – is consumed as edible products. For our last pearl together, we’ll talk about marijuana, edibles, and some important thingsRead more

The 52 in 52 Review: Targeted Temperature Management

Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-206.   What we already know about the topic: Patients generally have poor survival and neurologic outcomes after out-of-hospital cardiac arrest. After two studies in 2002 showed improved outcomes in patients with out-of-hospitalRead more

Digoxin Day, Part 2: Digoxin and ECGs

Welcome to Digoxin Day, Part 2! Like all sequels, this is sure to be even better than the original.   Cardiac Physiology of Digoxin: Cardiac glycosides increase parasympathetic tone by acting on the vagus nerve. They also depress myocardial tissue. Together, these actions cause a decreased rate of depolarization through the SA node and aRead more

Digoxin Day, Part 1: Calcium and Hyperkalemia

Digoxin is a cardiac glycoside, and it has a narrow therapeutic window (0.5-2 ng/ml). Due to its sub-milligram dosing, its dependence on renal clearance, and its interactions with many other drugs, digoxin toxicity is a real concern for patients taking this medication.   Digoxin and hyperkalemia: Hyperkalemia is frequently seen in the presence of digoxinRead more

Eye on the Prize: Can You Perform a Lateral Canthotomy?

When a patient presents with orbital compartment syndrome, performing a lateral canthotomy and cantholysis can be vision-saving. You may only have 60-100 minutes until the patient experiences permanent visual sequelae. Are you ready?   Indications: Indications to perform lateral canthotomy may be remembered with the mnemonic DIP A CONE. They include decreased visual acuity, intraocularRead more

The 52 in 52 Review: Sgarbossa Criteria

Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7.   What we already know about the topic: When a patient presents with acute myocardial infarction (AMI), time is myocardium – that is, the patient shouldRead more

Alright, alright, alright: Arrhythmogenic Right Ventricular Cardiomyopathy

When you examine the ECG of a patient who syncopized, what are you looking for? You’re probably checking for a prolonged QT interval, signs of left ventricular hypertrophy consistent with hypertrophic obstructive cardiomyopathy, a delta wave consistent with Wolff-Parkinson-White syndrome, and T-waves suggestive of Brugada syndrome. But is arrhythmogenic right ventricular cardiomyopathy (ARVC) on yourRead more

Opioid Prescriptions in the ED: How Many People Have You Hooked?

To call opioid use in the US a “problem” is a gross understatement, and most of us in Emergency Medicine appreciate this. You may believe that if you only prescribe a small number of pills to an opioid-naïve patient who is truly in pain, you are not causing harm. A new study in the NewRead more

Topical Toxicology: VX Gas and Kim Jong-nam

*Thanks to Dr. Clark Owyang for following this “case” with me!   On February 13, Kim Jong-un, son of Kim Jong-il and half-brother of current North Korean leader Kim Jong-un, was poisoned at Kuala Lumpur airport in Malaysia. He died shortly after. Yesterday, the Malaysian police reported that Kim Jong-nam died of exposure to VXRead more

The 52 in 52 Review: Steroids for Bacterial Meningitis

De Gans J, Van de Beek, D. Dexamethasone in adults with bacterial meningitis. New Engl J Med. 2002;347(20):1549-56.   What we already know about the topic: Bacterial meningitis is a dangerous condition with significant associated morbidity and mortality. Survivors often suffer neurologic sequelae. Bacterial meningitis frequently affects people who were previously healthy and high-functioning.  Read more