Vanc + Zosyn and acute kidney injury

Vancomycin and Piperacillin-tazobactam (Zosyn) are two widely used broad spectrum antibiotics most ED providers use severe infections and especially undifferentiated sepsis. These antibiotics together synergistically fight off  MRSA, Pseudomonas, and other dangerous gram negative and gram positive infections for our sick patients.  Often times we use Vanc and Zosyn without considering other antibiotic therapy optionsRead more

Time to Bind…

So you’re working a busy A side shift at Elmhurst and you get an alert from EMS about a polytrauma. The patient rolls through the door alert but moaning in pain with obvious road rash to the bilateral lower extremities. He states he was in a motorcycle accident. He’s tachycardic and hypotensive. After a negativeRead more

Sphenopalantine Ganglion Block for Headache

“I have a headache”….the number of times we as ED providers have taken care of a patient with this complaint is uncountable. Once we have established that the source of the headache is not life threatening we then move on to how to treat and make the patient more comfortable. Standard care of practice hasRead more

Insulin Bolus for DKA?….Not so fast

DKA is a very common endocrine emergency that we encounter very frequently in the ED in both pediatrics and adults. Standard therapy of care includes IVF, correction of electrolyte disturbances, +/- bicarb, and of course insulin. Prior to starting the insulin drip many providers administer an insulin bolus with the thought that it will overcomeRead more

Spontaneous bleeding is not the only side effect known to tPA

So you’re working a busy resuscitation shift when you are alerted by the triage nurse of a possible stroke with onset approx 1 hour ago. You go assess the patient and you find a 75 yr old gentleman with left sided facial droop, slurred speech, and left hemiparesis. The patient is rushed off to CTRead more

Amiodarone or Procainamide for the Acute Treatment of Stable Vtach?

Per ACLS guidelines, stable ventricular tachycardia can be treated with either IV Amiodarone or IV Procainamide. Clinically it appears that Amiodarone has been the preferred agent, although both drugs have received a class II recommendation. There is one study in particular, the PROCAMIO Trial, that compares the effectiveness of both drugs and their side effectsRead more

Nebulized TXA for hemopytsis

Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent used to treat many different bleeding complications. It’s implications in trauma as well as its various routes of administration including orally, IV, and topically have been well studied. However there are rather few studies that detail the benefit of nebulized TXA. One case in particular involving massiveRead more

Quadriceps tendon rupture. Xray or not?

The quadriceps tendon attaches the quadriceps muscle to the patella. Tears most often occur just above the insertion on the patella. They more commonly occur in men (8:1 ratio) and patients report hearing a popping sensation doing activities that involve a change of direction while jumping or landing from a jump. Diagnosis can often beRead more

Mandible Fracture? That’s what a tongue depressor is for…

So you’re working a Saturday overnight B side shift at Elmhurst. Its 3am and you have a patient in the hallway who looks questionably intoxicated and has been assaulted. Grossly he has no facial or head injuries (no lacs or abrasions) but you walk over to the patient and he is grabbing his jaw. YouRead more