Congratulations and Best Wishes to our Graduating PGY4’s

Congratulations to the graduates of the Class of 2016! –On behalf of the attendings for whom you lightened the burden, the residents for whom you paved the way, and the patients for whom you cared. Best wishes. Don’t forget to visit.    Read more

Jellyfish Sting Management: To Pee or not to Pee?

In preparation for July 4th weekend and upcoming beach season…let’s review a quick-to-read basic management of a jellyfish sting (not including those pesky Australian Irukandji jellyfish):   To inactivate nematocysts: Pour vinegar or acetic acid solutions for ~30 seconds (Grade 2C) Promptly remove tentacles to prevent continued venom release (avoid vigorous rubbing [Grade 1C]) Beware: detached live tentacles release venomRead more

US-Guided Femoral Nerve Block for Hip Fracture

In light of a recent patient in our ED with a femoral neck fracture…   Rather than dose and re-dose opioids, consider an US-guided femoral nerve block for safer, longer, and more effective analgesia [1-3].   Courtesy of Robert J. Strony DO, RDMS, RVT via    FN: femoral nerve, SFA: superficial femoral artery, DFA:Read more

Wellness Pearl: Tips/Tricks to Create More IPhone Storage Space

In light of my being called in for sick call today and working a shift, here are 2 short and simple Wellness Pearls brought to you by Abe Lishansky and Jeff Nusbaum, respectively.   Follow these steps to create about 1200 MB free space on your IPhone (Lishansky, 2016) –Go to Apple Store –Click to rent theRead more

ED Trick/Tips: IV Extension Set for Drainage Abscess

As the Teaching Resident in the ED this month, I have been asked to assist with a range of aspiration procedures, from peritonsillar abscess to paracentesis to priapism. Here is a procedural complication witnessed particularly for smaller residents with smaller forearms: The strength required for these providers to pull back on the syringe hinders their ability toRead more

Dental Fracture Classification and ED Management

Ellis Classification System Ellis I: extends through enamel (radiopaque) Ellis II: extends through dentin (less radiopaque; similar to bone) tender to touch/air visible yellow layer of dentin Ellis III: extends through pulp (radiolucent) tender to touch/air visible pink/red area at center of tooth  (EMedicine) ED Management Ellis I: smooth rough corners; no urgent care required; cosmetic follow-up Ellis II: coverRead more

Procedure Skill: Drainage of Ischemic (Low-Flow) Priapism

Inspired by the procedural skills of Dr.’s Lazarciuc, Milliner, and Rajpal… In brief, step by-by-step: Sterile field Dorsal penile nerve block: 2 cc of Lidocaine w/o Epi injected close to penile base, from 2 and 10 o’clock aimed toward center of shaft. Insert 19-gauge needle at 2 (and if needed, 10) o’clock. Can also use butterfly connected to syringe.Read more

Ultrasound Water Bath

After pulling in a spectacular toe-tapping sideline-hugging outstretched 30-yard bomb just milliseconds before a crushing hit by multiple defenders (a Pearl unto itself), one of our own right-handed residents came down the next day with redness, swelling, and pain to the dorsal aspect of his right hand’s third metacarpophalangeal joint. A heated discussion in theRead more

Mass Casualty Medical Triage

In light of the horrific mass casualty attack in Orlando, here is a review of the medical triage system for mass casualty events. Thoughts and prayers to the victims, their families, and all those affected.   Triage is used to determine who is most urgently in need of transport to a hospital (i.e. chance of survival, wouldRead more

Postpartum Hemorrhage Pearls

Here are some very-quick and easy-to-read pearls to remember for the dangerous immediate postpartum complication of postpartum hemorrhage.   Most common causes Uterine atony (by far) Trauma (i.e. lacerations, surgical incisions, uterine rupture) Coagulopathy (persistent heavy bleeding can lead to consumption of clotting factors) Management Uterine massage. Tamponade bleeding from uterine cavity. Two large-bore IV lines. MakeRead more