The Ten Commandments

Verbal de-escalation is a powerful and effective skill to help calm agitated and aggressive patients. This method is proven safe, effective and decreases the likelihood for restraints. Among properly trained physicians this process takes less than 5 minutes. Just follow these “10 Commandments.” Respect personal space. 2 arms length. Do not be provocative. Body language is important. Do not cross arms,Read more

Sugar the Rim

“Want to hear the funniest therapy that actually works?” – Dr. Ben Schnapp, former Chief Resident extraordinaire It was my first month of intern year, and I had just presented a patient with a recurrent rectal prolapse. Ben Schnapp, the senior resident, was delighted to show me what he said was the “the funniest therapy that actually works.”Read more

I hate Mondays!

Garfield had it right. Mondays are the worst.  Want proof? Well, in 2004 the CDC published a survey measuring health care utilization among US Emergency Departments over a 10 year period. The results? ED visits peaked on Monday and then decline throughout the week, and Medicare patients were more likely to visit the ED on a MondayRead more


If yesterday’s post on Roids didn’t get you jack’d then maybe today’s will! Here’s part deuce – Topical Steroids Spoiler alert – if you are using 1% hydrocortisone for every rash everywhere then you are likely underdosing! Dope up your knowledge with this killer chart. [pdf-embedder url=””] References: Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009 Jan 15;79(2): 135-40.Read more


Summer’s here! Time to hit the gym and review your steroid-knowledge. What’s the difference between prednisone/prednisolone/methyprednisolone again?  Well, I’ll give you a hint… its not a pre/post work out fix! Check out this chart below for a quick review. [pdf-embedder url=””] References: Tintinalli’s 7 edition, Chapter 132  Read more

Lumbar Puncture Pearls

Lumbar punctures (LPs) can be tricky even for an experienced provider. Here are some pro tips to help you look like an all-star! Set up: The LP tray contains only a small amount of  lidocaine (~3mls). If you need to make a second attempt in another intervertebral space you may not have enough remaining anesthetic. BringRead more

Kids eat the darndest things!

Did you know you can use a regular old metal detector to rule-in a metallic swallowed foreign body in children? It’s true! Several studies have been published in The Journal of Accident and Emergency Medicine out of  The Royal Hospital for Children located in Glasgow, Scotland. In one large prospective study,  186 children presented to the EDRead more