Bag Mask Ventilation During Intubation

A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study the use of bag-mask ventilation to prevent hypoxemia during intubation.  401 patients were randomized to either bag mask ventilation or noRead more

Pacemakers Review pt. 3

Today we will review complications associated w/ implanted pacemakers that you may encounter in the ED and thus ought to be familiar with. Generally, complications can be divided into two categories: early vs. late Early complications typically occur in the first 6 weeks and are related to the implantation procedure itself: venous access, lead positioning, tissueRead more

Pacemakers Review Pt. 2

Cardiac pacing as an intervention can be conceptualized as addressing problems in electrophysiological conduction and/or.  So, for example, if there is a disruption in the electrical continuity between the atrium and the ventricle, a pacer maybe function by detecting a normal sinus impulse in the atrium (there is typically a right atrial lead connected toRead more

Pacemakers Review Pt. 1

The pursuit of mastery over cardiovascular emergencies demands a rough familiarity with implanted devices which includes why they get implanted in the first place (indications), how they work, how they malfunction, and how they affect the EKG., among other features. Today we’ll we’ll start with the basics of implanted pacemakers including indications, anatomy, and radiography.Read more


Your patient has an SBO and has repeated bilious emesis on the side. The surgery team is in the OR and they ask if you can place the nasogastric tube (NGT). Lets review proper NGT placement and some new techniques that can facilitate placement.     SUPPLIES cup of water with a straw emesis basinRead more

Ouch that monkey bit me!

At the request of a colleague who recently treated a patient bitten by a monkey, I am going to write about treatment and prophylaxis for animal bites. First, a little BIT (get it?) about monkey bites. These are relatively rare in the US, primarily occurring in India or research labs. They have a high rateRead more

pediatric blood transfusion

So you’re in peds and your patient is anemic. You need to transfuse, but you are confused. How much blood do you give? How fast do you give it? How much: The volume of blood to be transfused may vary depending on the clinical scenario. The transfusion volume is usually 10 to 15 mL/kg. InfantsRead more

Spontaneous Pneumomediastinum

Your patient is a 24 yo M with chest pain.  It is pleuritic. He has normal vitals and you’re not too concerned. You get a CXR and you see the result in this post. He has pneumomediastinum! What is that? What do I Do now? Spontaneous pneumomediastinum is rare, occurring in approximately 1 in 30,000Read more

In flight emergencies and when to land the plane

You are on a flight, halfway across the Atlantic Ocean at the start of a much needed vacation, binge watching that new show everyone has been talking about but you’ve never had time to see.  Suddenly, the screen freezes and an overhead announcement interrupts your zen-like, screen-induced partial stupor.  “Is there a doctor on board?”Read more

PE risk stratification: which tool is best?

  Your patient with a newly diagnosed PE hates hospitals.  He or she agrees to defer to your judgement about admission versus discharge home, but makes it clear they would prefer to go home if it is safe.  Which tool should you use to help you decide? Up until recently, there were no prospective studiesRead more