Naloxone, for more than just opiate reversal

This week we have seen some interesting uses of naloxone in the Sinai ED, so let’s review: Naloxone for pruritis? Why yes. Several randomized controlled trials have shown Naloxone to be efficacious in all sorts of pruritic conditions – chronic urticarial, atopic dermatitis, Psoriasis Vulgaris – to name a few. The dose range is high,Read more

Name that plethoric structure…

We are all familiar with the RUSH exam (see Dr. Weingart’s original article if you’re not). Since it’s been a recurring theme this week, we are going to focus on the IVC measurement of the spontaneously breathing patient. This will not be a discussion of which method of volume status measurement is superior (i.e. legRead more

The Matt Egan’s Wrist Memorial Radiology Pearl

Name that fracture, ideal imaging modality, and treatment including indication for operative repair: That would be a classic scaphoid fracture. It should ideally be imaged first with a three-view x-ray (AP, lateral, and scaphoid view – 30 deg extension, 20 deg ulnar deviation), but an MRI is the most sensitive for occult fractures. CT withRead more

DKA without the ICU

As we discussed yesterday, the treatment algorithm for DKA is fairly straightforward with a few subtleties we rarely appreciate, until now. Yesterday we focused on fluids, today we move on to the insulin. Can we offer the patient anything else beside an insulin drip? Obviously the answer is yes, or else this pearl wouldn’t exist.Read more

Diluting your sugar

Last week, we closed out the week by discussing the dischargable, ‘benign sugars,’ but what about when you have the legit ‘sugars.’ We’re talking about DKA. While the algorithm for DKA is fairly straight forward – fluids, insulin, replete lytes prn, admit / ICU consult, there are some often under appreciated subtleties we neglect inRead more

The oft forgotten ‘centesis

Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis: Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion Contraindications: severe clotting abnormality (relative) Complications: Ptx, cough, infection, hemothorax, re-expansion pulmonary edema, air embolism. Technique: No specific technique has been shown to be superiorRead more

Doc, I got the sugars, I cannot go home? Or can I…

Before answering that question, I need to acknowledge EM topics ( for bringing this important article to my attention since this is nearly a daily occurrence in our ED. So, do you need to lower blood sugar to a magical, non-evidenced based threshold prior to discharge? Like everything, the answer is…. It depends, but inRead more

Tachypnea, Bradypnea, platypnea and orthodeoxia. Oh my! Wait what?

We are all too familiar with tachypnic and the occasional bradypnic patient (i.e. narcan deficient) rolling through resus, but rarely do we come across platypnic and orthodeoxic (except for yesterday). In order to come across them, you need to know what they are, so here we go. Platypnea is defined as dyspnea in the uprightRead more

Is that really necessary? Pretreatment for RSI

Intubating a patient with a suspected head bleed is one of the highest risk situations we encounter as ED physicians. A failed attempt with enough airway manipulation can potentially increase ICP and have profound negative effects on patient outcomes. EM dogma, perhaps antiquated, dictates pretreatment with an opiate, typically fentayl, and lidocaine. But is theRead more