Succinylcholine in Myasthenia Gravis

Case: 45yoF with myasthenia gravis presents in respiratory distress.  She requires urgent intubation.  Which paralytic will you use?  Myasthenia gravis is an autoimmune neuromuscular disorder in which antibodies target nicotinic acetylcholi…


Case: You are working in the resus room, when a 65yoM h/o CAD, severe aortic stenosis, dilated cardiomyopathy (EF 15%), presents short of breath in extremis. VS: 75/60, HR 119 RR 24, T98.0, Sp02 94% on NRB He has rales to the apices of the…

August Q-tips

Patients with lower quadrant pain should typically have gonadal examinations. There are relative exceptions–such as virginal women without history of pelvic examinations or IBD patients with symptoms very typical of previous IBD flair…

Physical Exam in Septic Arthritis

CASE: 40yoM no PMHX with a swollen, painful right hip joint.  Worsening x5 days. No history of prior episodes, no other joints involved, no fever, no trauma, no GU symptoms, no rash, no vision changes, no IVDU. On exam, pt is afebrile, nont…

Meconium Staining

26 yoF 36 weeks by dates presents to the ED in labor, and has a precipitous birth in the resus area.  The infant is covered with a greenish liquid the consistency of split-pea soup. How do you address this?

Tip of the hat to Dr. Blaivas who forwarded the link to this free OB GYN ultrasound ebook. The book is a PDF download.  The authors also maintain a fairly extensive YouTube Channel that is worth a look. Phil

Ddavp for Hemorrhage in Esrd Patients

CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopa…

Bp Goal in Intracerebral Hemorrhage

55 yoF h/o HTN presents BIBEMS with acute onset decreased level of consciousness, onset 3 hours prior to arrival. BP 220/140 HR 50 T 98.0 RR 10 SPO2 92%. Pt is obtunded, no localizing neuro findings. Pt intubated for airway protection. CT s…

September 2014