Despite warnings by the FDA in 2013 to stop prescribing codeine to children due to the risk of respiratory depression and death, a study to be released this week in Pediatrics indicates that 5% of children post-tonsillectomy/adenoidectomy a…
Article Citation Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, et al; Pediatric Emergency Care Applied Research Ne…
A 91 yo female presents with sudden onset right arm pain with decreased pulses. Since arrival to the ED, her mental status has also progressively decreased. Her blood pressure is 170/60, HR 60, T97.8, RR20, sats 100% RA. You suspect she has…
Article Citation Chang AK et. al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity…
17 yo female with progestin secreting IUD, LMP 9/22/17, no prior medical problems presents to the ED with bilateral lower abdominal pain for the last day. She also notes that she has had some intermittent vaginal bleeding for the last 3 wee…
Article Citation Hacke W, Kaste M, Bluhmki E, Brozman M, et al; ECASS Investigators. Thrombolysis with alteplase 3 t…
21 yo male presents with laceration over his distal 4th metacarpal. Initially the patient doesn’t recall how the injury occurred, but with additional probing you discover he was in an altercation last night and punched another person in the…
A 74 yo female with hx of diabetes, HTN presents to the ED with new onset painless left sided diplopia for the last 24 hours. No change in visual acuity. The patient has no other symptoms. You examine the eye and left sided ptosis and a “do…
Article Citation: The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute iscAhemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7.PMID: 7477192 What we already knew abo…
You have a patient who is in acute renal failure. You have sent an ER-venous panel that shows a Cr of 4.6, a BUN of 95, and a K of 6.5. You discuss these findings with your nephrology colleagues who request you get the “more accurate” basic…
74 yo F with hx of CAD, afib, HLD, severe LV dysfunction is brought in by EMS as a notification for a STEMI. A 12-lead EKG in your ED shows the same as the EMS EKG. Should you activate the CATH lab? Answer: Check an old EKG. An old E…
So, you’ve just finished suturing an uncomplicated laceration and you think to yourself: should I apply antibiotic ointment or just cover with a bandage with good return precautions? Answer: There is some limited evidence to support…
Article Citation: Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, et al; DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003 Aug 21;349(8):733-42. PMID:…
There may be. Traumatic lumbar punctures occur in up to 30% of lumbar punctures. An observational, multicenter cohort study by Jeffrey Perry et. al. attempted to answer this question and enrolled sequential patients with acute…
A 3 week old male, born NSVD 40w6d, presents to the ED with 2 days of feeding intolerance. Initial vitals show a heart rate of 260, bp 83/51, RR 40, sat 100% RA, temp 37C. You quickly get an EKG pictured below that shows a regular, narrow c…
