Central Line Wizardry

I was scrolling through twitter this morning when I came across a quick video from @CriticalCareNow for an awesome central line trick. And then I went to his feed and found some more. They are pretty genius and I think I’ll start using a few. Check out Dr. Haney Mallemat’s twitter at @CriticalCareNow for videoRead more

Let’s wait for the “official urinalysis”….?

Chances are you order a urine dip or urinalysis on a good number of your patients each shift. But how good are these tests at helping us diagnose a urinary tract infection? The short answer: not fantastic. Let’s continue, focusing on the “official UA”.  When looking at the UA results to determine if a patientRead more

National Physician Suicide Awareness Day

This past Tuesday (September 17th) was the first annual National Physician Suicide Awareness Day. CORD, ACEP, SAEM and a number of other EM organizations paired with organization from other specialties to raise awareness of the epidemic. It’s an effort to break down the stigma surrounding mental health, open the conversation to make change, and toRead more

M is for morphine

Remember MONA (morphine, oxygen, nitro, aspirin) from med school? Well, she may be just “A” now…. Over the years, all of these treatments (except for good old aspirin) have become somewhat controversial in the treatment of ACS. Let’s focus on morphine today. Morphine’s obvious benefit is its ability to control pain and therefore decrease sympatheticRead more

Meningitis Prophylaxis

Have you ever taken care of really critical, undifferentiated patient, only later to find out that they were diagnosed with a serious, contagious illness? We are exposed to innumerable pathogens each day in the ED, but there are only a few that necessitate antimicrobial prophylaxis and even fewer that require prophylaxis from simply being veryRead more

The Betel Nut: an oral carcinogen

Ever walk up to a stable, comfortable appearing patient at Elmhurst and their mouth/teeth are completely RED? Or maybe like a dark brownish/black color? Like this?? It really scared me the first I saw it as an intern. I must have asked her 100 times if she was vomiting blood. But the patient said sheRead more

The Fascia Iliaca compartment block: as magical as it sounds!

In case you haven’t gotten to this month’s EM:RAP, there’s a really great segment on an important ED procedure that we definitely don’t do enough of in the ED: the nerve block. The section discusses the femoral nerve block and how to perform a fascia iliaca compartment block (the “3-in-1” block)–which hits 3 major nervesRead more

Hurry Up & RUSH!

You’re working in RESUS, and you get a notification for hypotension. He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. You don’t see any signs of trauma. Your attending suggests performing a RUSHRead more

Supplemental Oxygen: a cautionary tale.

You’re working in the Cardiac Room as a new PGY-2 and the triage nurse calls you to evaluate a patient. He’s about 40 years old, slightly overweight, known to the ED for chronic alcohol abuse, and appears to be intoxicated yet again.The nurse tells you that when she checked his vitals, his O2 sat wasRead more

Lumbar Puncture: the aftermath (aka how do i label the tubes?!)

Alright, you did it. LP complete! You look at those crystal clear tubes, and say to yourself…. “Ohhh yeah, champagne tap!” But then…you realize you ordered 9000 tests on these few drops of precious fluid and have no idea how to correctly ship them off to the lab. First, you ask around. No one seemsRead more