Plasmalyte in hyperkalemia

A patient with end-stage renal disease on dialysis presents with hypotension and sepsis. He is also hyperkalemic. How do you fluid resuscitate him? Prior teaching was to never give potassium-containing solutions to a hyperkalemic patient. H…

Painless Foley insertion

A 57yo M presents with new onset urinary retention for 3 days. The triage nurse attempts to place a foley catheter but is unable to pass it. Bedside ultrasound confirms a distended bladder. The patient is now complaining of urethral discomf…

DAWN of a new era in stroke care

Thrombectomy performed within 6 hours of symptom onset has been demonstrated to significantly improve clinical outcomes after stroke. Though there is generally diminishing benefit with increased time interval from last known well to the tim…

C1 Esterase Inhibitor Deficiency

A 67 year-old man presents with lower lip swelling for the past two hours, and tells you he was recently diagnosed with acquired C1 esterase inhibitor deficiency. He has normal vitals, is speaking in full sentences, and denies any sensation…

Troubleshooting PEG tubes

A patient is sent from nursing home at 10pm for a non-functioning PEG tube. He has a prior history of stroke with L sided weakness and is now bedbound at baseline. He has stable vitals, no abdominal tenderness, and is otherwise well appeari…

Median and Ulnar Nerve Blocks

Injuries to the hands are a frequent complaint in the emergency department. When the injury isn’t limited to a single digit, or involves larger areas of the hand such as a burn or deep laceration, a nerve block can be an effective opt…

March 2018