Does roc rock and suc suck?

A study just published this month in Annals of Emergency Medicine compared the 2 most common paralytics we use in the ED for RSI, rocuronium and succinylcholine. The primary outcome studied was first pass success rate, and the secondary outcome was adverse effects including cardiac arrest, hypotension, dental trauma, and dysrhythmias. While succinylcholine used to beRead more

Opioid Conversions

Shoutout to RTO for this tidbit he learned from palliative care on a quicker way to do opioid conversions. Thought I’d share it with you all! Have you had patients who are on opiates at home, need pain relief, not exactly sure how much they may take at home or where to start? Just confusedRead more

Acute Flaccid Myelitis

We’ve gotten an email or two telling us to look out for Acute Flaccid Myelitis (AFM). What is it? Why does it matter? AFM causes flaccid weakness to one or more limbs rapidly in a polio-like neurologic fashion. There can also be cranial nerve involvement, including ophthalmoplegia and dysarthria. There were 80 cases in theRead more

To bicarb or not to bicarb

When, if ever, should we be giving bicarbonate in patients with metabolic acidosis? A study published in The Lancet in July 2018 involved a multicentre RCT in 26 ICUs with 400 patients, called the BICAR-ICU trial. It found that in severe acidemia (<7.2), sodium bicarbonate infusion compared with no infusion did not decrease mortality overRead more

PTSD in EM Residents

Winter is here. It’s colder. Sometimes we don’t see the sun for days. Let’s take a moment to think about some mental health issues. Published in Annals of Emergency Medicine in December 2017 was a piece by some of our very own (Lara Vanyo, Randy Sorge, Angela Chen, and Daniel Lakoff) on posttraumatic stress disorder (PTSD) inRead more

Foot vs Bus

In a totally hypothetical situation, imagine a resident’s foot got run over by a bus and looked like this after arriving in your ED… What sort of things should you be concerned about in injuries like this of extremities? 1. Vascular: Has a vessel been compromised, especially an artery? It is important to control hemorrhage.Read more

The Golden S Sign

Shoutout to the awesome David Cisweski for following up this tidbit from conference and giving us this pearl. Remember in conference when Dr. Jacobi was going over chest X-rays, was talking about the Golden S sign, and we could neither see the S nor the gold? What? – The Golden S sign is also referred to by the moreRead more

SVT and Paranasal Etripamil

Have you had one of those resus shifts where everyone and their mother seems to be in an arrhythmia? Have some of them been older patients with SVT that just make you a little antsy about giving medications like adenosine multiple times after Valsalva maneuvers haven’t worked or then having to try an IV betaRead more

Air Pollution and Stroke?

One growing global health issue is ambient air pollution. One of the leading risk factors for disease is fine particulate matter in outdoor air. The WHO states 1 in 8 deaths is due to air pollution. So what is it’s effect on cerebrovascular disease? In Annals of Emergency Medicine from this month, a study was publishedRead more

Nursemaid’s Elbow Reduction

Radial head subluxation, more commonly known as nursemaid’s elbow, can be seen more frequently in the pediatric population. Imagine a parent quickly pulling a child’s arm (usually 1-4 years old) that was held in extension in order to prevent a fall — the kid then holds their forearm in the pronated position and close toRead more