This Sept 2015 Annals of Surgery article made a splash when it first came out a year ago, and it came up again yesterday in conference. Here’s a refresher. FAST ultrasound examination as a predictor of outcomes after resuscitative tho…
We do a lot of diagnostic taps at our shop. People need to take better care of their livers. Here’s a tip for your next tap. I recently encountered a very obese cirrhotic patient who required a diagnostic tap. He had several very deep…
Today, instead of talking about tapping a joint to pull fluid out, we’re going to talk about tapping a joint to put fluid in. Methylene blue, in fact. The methylene blue joint injection test is a fast and simple bedside test that can…
A middle-aged man presented to the ED with chest pain for the past 2 hours. This is his EKG. What’s your next move? If you look at the anterior leads, you’ll notice upsloping ST depressions and tall,…
The traditional dosing range of ketamine for analgesia is 0.1-0.6mg/kg IV. It’s funny to use the word traditional because ketamine is still not completely universally considered an option for analgesia, despite its increasingly wider…
A blind digital intubation involves using one’s own fingers to feel the laryngeal inlet and then guide an ETT or bougie into the trachea. Read about it, but never thought I’d see it in the ED. Until recently as an almost last re…
Chief Complaint: Pregnant, vaginal bleeding An evaluation of first trimester vaginal bleeding certainly entails a pelvic exam and a bedside ultrasound to eval for ectoptic pregnancy. We are looking for an intrauterine pregnancy. You…
How do you calculate the correct ETT size for a child in a pediatric resuscitation? ETT size = (age + 16) / 4 ETT size = (age/4) + 4 ETT size = 4 + 1/4 age If you find yourself thinking about the order of operations (PEMDAS for anyone who m…
It’s not just about the squeeze. You gotta think about the filling. Yes, today we’re talking about diastology (I didn’t make that word up) AKA diastolic heart failure AKA heart failure with preserved ejection fraction AKA…
Take a look at the above EKG. If you saw this in a 70 year old patient with chest pain, you might be a bit concerned. Tachycardic, inverted T waves anteriorly, a partial RBBB in V1. Are these ischemic changes going on? Where is this…
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…
