A Bucket O’ Blood

You are taking a water break during your resus shift when you hear “clinical upgrade, acute zone 1”. You rush back to see a 60-year-old patient holding a bucket of bright red blood and you find out that he has an extensive PMH including Hep…

Status Epilepticus

Your patient arrives by ambulance having a seizure.  EMS administered ativan 10 minutes ago.  You give a second dose but the seizure continues.  What should you do?

Interscalene Plexus Block

Your patient is a 25 year old male with a shoulder dislocation.  He needs analgesia, but has a date later and does not want to risk dimming his considerable mental acuity with systemic medications.  What to do?


You are managing an elderly patient with septic shock.  The ICU team is requesting ScvO2 measurement to be used in consideration of inotropic support.  You are not sure how to make decisions about inotropes based on ScvO2 and wonder:  What…

Pharmacological Treatment of Achalasia

Your patient is 54 years old, otherwise healthy, and presents with symptoms of achalasia.  He has a follow a up appointment with a gastroenterologist in one week but is having severe pain and regurgitation with meals and is not able to move…

Six of One, Half Dozen of the Other?

Your patient is a 50 year old male who presents with head trauma.  He takes aspirin daily.  Neuroimaging demonstrates subdural and subarachnoid hemorrhage.  You plan to treat with DDAVP and platelet transfusion.    When ordering the platele…

P or Iup?

A G1P0 10-week pregnant female presents to the ED with lower abdominal pain and vaginal spotting. She’s had no prenatal care. Being the highly motivated resident that you are, before even the urine is collected and the pregnancy is verified…

Activate the Cath Lab? Not So Fast.

The traditional teaching (and pre-2013 ACC/AHA guidelines) for a new left bundle branch block (LBBB) on EKG (shown above) is that it is a STEMI equivalent and the cath lab should be activated. However, recent evidence in the last several ye…

Stroke or Discharge?

It’s 4pm on Monday and you’re the resus resident at Sinai with all 5 beds full and 2 more waiting in the hallway. Despite channeling your inner Stephanie Hernandez you’re still completely overwhelmed. The triage nurse calls yet another resu…

August 2015