Steri-strip and Suture Combo Technique for Repairing Fragile Skin Old people. They come with all sorts of problems and complications. Even simple lacerations are more complicated with them. Have you ever encountered a laceration in…
All the hard parts are done in the placement of your central line. You nicked the vein and NOT the artery. The wire threaded smoothly. You got confirmation on your ultrasound. Now, you just insert the triple lumen in over the wire. Insertin…
This week we have seen some interesting uses of naloxone in the Sinai ED, so let’s review: Naloxone for pruritis? Why yes. Several randomized controlled trials have shown Naloxone to be efficacious in all sorts of pruritic conditions – chro…
Verbal de-escalation is a powerful and effective skill to help calm agitated and aggressive patients. This method is proven safe, effective and decreases the likelihood for restraints. Among properly trained physicians this process takes le…
“Want to hear the funniest therapy that actually works?” – Dr. Ben Schnapp, former Chief Resident extraordinaire [spacer height=”20px”] It was my first month of intern year, and I had just presented a patient w…
Garfield had it right. Mondays are the worst. [spacer height=”20px”] Want proof? Well, in 2004 the CDC published a survey measuring health care utilization among US Emergency Departments over a 10 year period. The results? ED v…
We are all familiar with the RUSH exam (see Dr. Weingart’s original article if you’re not). Since it’s been a recurring theme this week, we are going to focus on the IVC measurement of the spontaneously breathing patient. This will not be a…
Name that fracture, ideal imaging modality, and treatment including indication for operative repair: That would be a classic scaphoid fracture. It should ideally be imaged first with a three-view x-ray (AP, lateral, and scaphoid view – 30 d…
As we discussed yesterday, the treatment algorithm for DKA is fairly straightforward with a few subtleties we rarely appreciate, until now. Yesterday we focused on fluids, today we move on to the insulin. Can we offer the patient anything e…
Last week, we closed out the week by discussing the dischargable, ‘benign sugars,’ but what about when you have the legit ‘sugars.’ We’re talking about DKA. While the algorithm for DKA is fairly straight forward – fluids, insulin, replete l…
Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis: Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion Contraindication…
Before answering that question, I need to acknowledge EM topics (http://www.emtopics.com/article-a-day/2016/discharge-glucose-level-is-not-associated-with-return-to-ed) for bringing this important article to my attention since this is nearl…
We are all too familiar with tachypnic and the occasional bradypnic patient (i.e. narcan deficient) rolling through resus, but rarely do we come across platypnic and orthodeoxic (except for yesterday). In order to come across them, you need…
Intubating a patient with a suspected head bleed is one of the highest risk situations we encounter as ED physicians. A failed attempt with enough airway manipulation can potentially increase ICP and have profound negative effects on patien…
If yesterday’s post on Roids didn’t get you jack’d then maybe today’s will! Here’s part deuce – Topical Steroids Spoiler alert – if you are using 1% hydrocortisone for every rash everywhere then you…
