A 54-year-old suicidal patient presents to the ED after an unknown ingestion. Vitals are 98.9, 102, 18, 111/74, 97%, fs 98. She is somnolent but arousable. You send labs and find that the patient has an anion gap of 20, osmolal gap of 62…
Do central line-associated bloodstream infection (CLABSI) rates differ based on whether they were placed in the ED versus the ICU? A recent article published in Academic Emergency Medicine attempted to answer this very question. Central lin…
aVR is the neglected cousin of the other ECG leads. He doesn’t always make sense, nobody really understands him, and he usually sits alone at the dinner table. This is to the detriment of those who ignore him, as aVR can easily lead clinici…
I once lost a 25 year old on a cardiac shift. Later, after the shift ended, I was thinking of his whole life gone and wondering if I could have done more, performed more excellently. I wondered if another resident would have lost him if in…
“Lack of support in hospital/department. Social isolation, Lack of free time. Loss of confidence in your own abilities.” “…the fact that everything is on you…to push patients, to draw labs, to call consults, to juggle everything and have ex…
“I’m worried about losing my sense of humor…sometimes situations make me feel I’m losing that and then I’m just bitter.” “I actually think I’ve retained my compassion and empathy well…I think I have gained skepticism perhaps in exess of wha…
By @benazan Free Open Access Medical education (FOAM) began as medium for accelerated knowledge translation of cutting edge medical knowledge and as a virtual community of practice for ED physicians. As it matures, it’s grown to inclu…
The loop technique involves making two incisions at either pole of a skin abscess to initially drain its purulent contents. A loop drain is then inserted into one incision site and out the other, tied off above the skin with some movement o…
The two-point compression ultrasound exam assesses the lower extremity venous system at two points: common femoral vein and popliteal vein. Signs of DVT include lack of compressibility and visualized thrombus. [1]
Diagnostic abdominal paracenteses are frequently performed in the ED for patients with known liver disease. What complications can occur? What if the INR is elevated, as in many patients with liver disease?
A 40 y/o G10P10 presents with RUQ pain worse with fatty foods. When evaluating for acute cholecystitis, what 5 sonographic findings do you look for? What is the Mickey Mouse sign? What is the mantle clock sign?
An 80-year-old male is brought by family for AMS. On initial assessment: BP 86/45, HR 160s, in AFib, tachypneic. While addressing the ABCs, you’re also wondering what diagnostics can be performed immediately to help evaluate this undifferen…
32M BIBEMS s/p SW to abdomen. He becomes hypotensive/tachycardic, becomes less responsive. Massive transfusion protocol is initiated. What electrolyte abnormality is caused by massive transfusion? In the 1:1:1 ratio, are we talking about a…
You are evaluating a 65yo male with PMH CHF presents with severe sepsis. You’d like to administer IV crystalloids but you’re not sure how much should be given. What are some tools to assess for fluid responsiveness?
A recently published retrospective study in the Annals of EM supports the use of an age-adjusted d-dimer cutoff when evaluating patients with possible PE. Standard cutoff = 500 ng/dL; Age-adjusted cutoff = patient’s age x 10 Click for more…
