Agents that Can Precipitate Serotonin Syndrome Cocaine MDMA Tramadol Cyclobenzaprine Dextromethorphan St. John’s Wort MAOI Fentanyl Treatment for serotonin syndrome involves supportive care, discontinuing the offending agent, and prov…
(Previous posts: work of breathing, mode of ventilation, ventilator alarms) NOTE: this is NOT a peer-reviewed post (pending) and is continuously under construction on the sinaiem.org website! (Last update: 4/18/20) Airway pressure release ventilation (APRV) was used historically as a rescue mode for ARDS, which is classically characterized by heterogeneous lung injury resulting in uneven [...]
(Previous posts: mode of ventilation, work of breathing) As the ventilator alarm grows louder and louder as you walk closer to the room of the patient you just intubated, you review the "DOPES" mnemonic in your head. Except that in the COVID era, you have to be careful with aerosolization (can't BVM or allow ETT [...]
All of this discussion hinges on understanding the origins of air FLOW. A pressure differential or gradient is the key requirement. Tachypnea is the expected response to lung inflammation that produces stimulation of irritant, stretch, and…
(Previous post reviewed work of breathing, next post: ventilator alarm) Even though we often place patients on "volume-control ventilation", the goal of this post is to precisely define the mode of ventilation, which is often inconsistently or loosely described. It will hopefully serve as the foundation for characterizing other advanced modes. The mode of ventilation [...]
If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. And the key to understanding hyponatremia is…
As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all know this, but don’t…
the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates…
Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possibly answer this phenomen…
Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium to review the physiology of flui…
You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buff…
You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate was in the 150s — n…
Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ea…
Your patient in intake is miserable. Doubled over, complaining of pain everywhere, sweating, ill-appearing but not unstable. He tells you that the last time he used heroin was two nights ago, and he is asking for help. How do you treat this…
As the late spring rains have begun to fade and the temperature rises mercilessly into the 80s and beyond, summer is finally upon us. And with summer comes a host of diseases for the emergency physician to consider. Heat stroke, mosquito- a…
