Just a simple guaiac test….but what makes it tick?

Lets be honest: whether you like it or not, it’s a rare day working in the ED when you don’t guaiac someone. To “guaiac them” is of course slang for performing a point of care fecal occult blood test. Its a valuable tool and can yield useful clinical information when used appropriately. But do youRead more

A V-Tach of Another Color

Here’s an EKG you may never have seen before.  Only slightly frightening, right?  The rate is tachycardic and the width of the QRS tells you that it is coming from below the AV node.  The defining feature here is that the QRS complex alternates from left to right axis between beats.  This EKG is a rare rhythmRead more

Know Your A-Lines (Part 2)

Once you understand the basic functions of the components of your arterial line set-up and know how to position it properly the next level of mastery involves spotting other errors and optimizing them. If you notice that your pulse pressure is very wide your patient may be severely volume depleted, they may have profound aorticRead more

Know your A-lines!

Arterial lines can provide accurate, real-time information on your patient’s blood pressure.  They can be vital in cases where you want to trend precise blood pressure goals or where BP cuffs are producing incongruous measurements in a critically ill patient.  However, as with all tools the information they yield is only as good as the assayRead more

Salicylates, they can really go to your head.

Salicylate toxicity has a long history of causing morbidity and mortality in ED patients. Historically there has been a decline in the number of cases of salicylate poisoning due to concern regarding Reye’s syndrome. However, in recent years worries have spurred a public health campaign to spread information regarding the risks of poisoning by theRead more

Stones in bad places!

A Trichobezoar A 45 year-old female with hx of anemia presents to your ER complaining of 2 days of abdominal pain with nausea and several episodes of dark emesis but otherwise conversant and non-toxic in appearance.  She has not passed stool or flatus for 1 day.  She reports that she recently felt fatigued and tooRead more