Put down that FOBT

“The HgB has dropped, have you checked a guaic?” How many times have you checked a FOBT in your workup for anemia? Let’s take a look at what FOBT is supposed to be used for. FOBT is a visual stool assay in which heme in the stool reacts with reagent hydrogen peroxide to oxidize guaiac, leadingRead more

Ketamine PSA with Desaturation

During a busy day in the ED, it becomes apparent that the pulling and yanking on your patient’s shoulder has done absolutely nothing to reduce their shoulder. You perform your pre-procedure PSA Checklist, know that this young and active 18 year old poses little difficulty, and push your desired dose of ketamine. Suddenly, you notice theRead more

Sinusitis In Pediatrics?

You’re working in pediatrics, when a mother comes in stating her 5 year old has sinusitis. He presents with fever, cough, runny nose, and some discomfort over where his frontal sinuses are. Does he have sinusitis? Not so fast! The ethmoid and maxillary sinuses develop during gestation, and are therefore present at birth. The sphenoidRead more

Ring Removal

Over the past week, we’ve had a strange uptick in number of patients presenting to the ER with rings stuck on their finger. This is a quick review on the options that you have regarding how to remove them. Assuming your patient has tried soaking their hand, and tried soap to remove it, there areRead more

TPA For Minor Stroke?

  So, you’re working in the ED when a new stroke code is activated. You walk over and see a young gentleman with the complaint of left facial tingling, right arm and leg weakness with some tingling. Overall though, a relatively well looking person with mild deficits. Neurology gets there, the patient is whisked offRead more

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

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

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

Street Stats: The Bonferroni Correction

Tl;dr: (1) Expected false positive rate for any one statistical test is generally 0.05 (aka, alpha). But this error compounds when you run multiple statistical tests. (2) Adjust your target p-value by applying the Bonferonni correction (0.05/n where n = # statistical to tests) to see if authors’ findings are truly consistent with their reportedRead more