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

Tis the season – for rhinosinusitis

It’s an intake shift and yet another person comes in saying, “I feel congested doc. I need antibiotics for sinusitis.” A recent Cochrane review published in September 2018 that included 15 trials involving 3057 patients reviewed the need for antibiotics in acute rhinosinusitis (infection of the nasal passages and paranasal sinuses of less than 4Read more

Corticosteroids in Septic Shock

Should patients in septic shock get corticosteroids? A meta-analysis of 22 randomized clinical trials (RCTs) published in Intensive Care Medicine in July 2018 compared low-dose steroids vs placebo in adults in septic shock. It found that giving steroids (typically hydrocortisone) did not affect short or long term mortality, but found that the duration of shock,Read more

The Sinai Troponin

What is Sinai’s troponin assay? Answer: ARCHITECT STAT Troponin-I A Global Task Force with involvement from the American Heart Association (AHA), American College of Cardiology Foundation (ACCF), European Society of Cardiology (ESC), and World Heart Federation (WHF) agreed on a universal definition of myocardial infarction that supports use of cTnI as a preferred biomarker for myocardial injury. Elevated levelsRead more