On Not Crackin Dat Chest

This Sept 2015 Annals of Surgery article made a splash when it first came out a year ago, and it came up again yesterday in conference. Here’s a refresher. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation” by Inabi et al. Inabi and company looked at 187 traumatic arrestsRead more

Tap dat obese belly

We do a lot of diagnostic taps at our shop. People need to take better care of their livers. Here’s a tip for your next tap. I recently encountered a very obese cirrhotic patient who required a diagnostic tap. He had several very deep pockets that were amenable for tapping on bedside ultrasound. The problem wasRead more

Tap dat joint…with Methylene Blue

Today, instead of talking about tapping a joint to pull fluid out, we’re going to talk about tapping a joint to put fluid in. Methylene blue, in fact. The methylene blue joint injection test is a fast and simple bedside test that can be performed in the ED to assess joint capsule integrity in periarticularRead more

(De) Winter is coming

  A middle-aged man presented to the ED with chest pain for the past 2 hours. This is his EKG. What’s your next move?       If you look at the anterior leads, you’ll notice upsloping ST depressions and tall, symmetric, prominent t waves. This pattern is known as De Winter’s T wave pattern.Read more

Dosing that Special K for pain

The traditional dosing range of ketamine for analgesia is 0.1-0.6mg/kg IV.  It’s funny to use the word traditional because ketamine is still not completely universally considered an option for analgesia, despite its increasingly wider acceptance in the ED and growing amount of research literature supporting its use as an analgesic agent. It’s still technically off-labelRead more

You want me to stick my finger where?

A blind digital intubation involves using one’s own fingers to feel the laryngeal inlet and then guide an ETT or bougie into the trachea. Read about it, but never thought I’d see it in the ED. Until recently as an almost last resort. So I thought it was worth looking into it a bit. WeRead more

Don’t forget about the linear probe!

  Chief Complaint: Pregnant, vaginal bleeding An evaluation of first trimester vaginal bleeding certainly entails a pelvic exam and a bedside ultrasound to eval for ectoptic pregnancy. We are looking for an intrauterine pregnancy. You know the feeling. Please, just let me visualize an IUP! If you still haven’t tried using the linear probe toRead more

Broselow to the Rescue!

How do you calculate the correct ETT size for a child in a pediatric resuscitation? ETT size = (age + 16) / 4 ETT size = (age/4) + 4 ETT size = 4 + 1/4 age If you find yourself thinking about the order of operations (PEMDAS for anyone who missed elementary school math class) duringRead more


It’s not just about the squeeze. You gotta think about the filling. Yes, today we’re talking about diastology (I didn’t make that word up) AKA diastolic heart failure AKA heart failure with preserved ejection fraction AKA that other heart failure.   Your patient with a history of CAD and HTN rolls in acutely short ofRead more

Baby Hearts and Flipped T Waves

  Take a look at the above EKG. If you saw this in a 70 year old patient with chest pain, you might be a bit concerned. Tachycardic, inverted T waves anteriorly, a partial RBBB in V1. Are these ischemic changes going on? Where is this man’s prior EKG?! But wait, here’s the good news.Read more