The Ectopic Brain

Apps that make your EM life easier   1. How can I keep notes/articles/links/logins with me at all times? -download app Evernote (download to your phone and to you computer) -start with a shared notebook, PV cards from Michelle Lin 2. How about that crashing pediatric patient, what dosage of succinylcholine should I use? -downloadRead more

Tachycardia After Sedation

60F with a history of Hepatitis C cirrhosis presents to the ED with acute onset of hematemesis. She is treated immediately with two large bore IVs and her airway is successfully secured with RSI, using Ketamine and Rocuronium. She is treated initially with Protonix and Octreotide as per gastroenterology’s recommendations. She is given Ceftriaxone empiricallyRead more

Not Your Usual Obstruction

8 year old male who recently immigrated from Thailand presents to the emergency department with bowel distension, constipation, and non-bloody vomiting. His mother notes that one week prior the patient had non-bloody diarrhea associated with diffuse abdominal pain. The patient has had recurrent diarrhea for several months associated with a mild cough. The mother statesRead more

Interesting Therapy

33M with no PMH presented to the ED with one day of palpitations, complicated by a week of nausea, non-bloody non-bilious emesis, generalized weakness. On physical exam, the patient is diaphoretic, tachycardic with atrial flutter to 140s,  febrile to 103F, initially AO x3, but now becoming drowsy and fatigued. The patient denies headache, neck stiffness,Read more

Syncope with a Deadly Ekg

33 male-smoker, denies cocaine use or family history of sudden cardiac death, presents to the ED with dry cough, chills, myalgias x 1 week now complicated by one episode of syncope one-night prior without any chest pain, palpitations, SOB, incontinence. After having LOC, he awoke, crawled into bed and went to sleep. The next dayRead more

Use of Permacath for Iv Access

54F history of hypertension, diabetes, and ESRD presents to your Emergency Department hypotensive and febrile, nurses are hunting for IV access and unable to obtain any peripheral access, what can you do for access?     Answer: Use the Permcath 1. identify blue port 2. remove blue cap, withdraw and waste 5 mL (tubing mayRead more

Chest Pain After Endoscopy

46F sent from GI after undergoing endoscopy with biopsy for an esophageal mass, the patient had acute onset of substernal chest pest pain and was transferred to the ED for evaluation. EKG is normal. Chest x-ray is pending. The patient has stable vitals, maintaining her airway. On exam, the patient is uncomfortable, but otherwise noRead more