23 yo M w/ no known PMHx presents to the ED BIBEMS for AMS. Patient is awake but appears slightly confused, he is salivating and spitting in the ED but able to protect his airway and his vitals are stable, he has no signs of trauma, no abn…
Elderly female w/ PMHx of TIA, DM, and remote breast Cancer history reportedly in remission presented to the ED w/ c/o R-sided neck pain radiating to her R trapezius for 2 days. No fevers or chills, no Hx of trauma or falls, no vision chan…
For Patients in Cardiac Arrest use LMA until there is ROSC and situation under control Induction Agents Etomidate: 0.3mg/kg IV dose, “cardiac Stable,” unclear effect if dose decreased, may not be ideal for patients…
17-month-old F w/ no sig PMHx presents to the ED accompanied by her mother who is concerned because her baby is “acting drunk.” Mother reports child was staying with grandparents over the weekend and today began “walking f…
Interesting Case of Facial Swelling. 55 yo F w/ PMHx of HTN, DM, and ESRD on HD presented to the ED w/ c/o facial redness and swelling progressively worsening for 3 days. Patient discharged 7 days prior from outside hospital but una…
Most toxic mushroom ingestions simply result in abdominal cramping, nausea/vomiting and diarrhea. But beware of amatoxin-containing mushrooms appropriately termed the “deadly white Amanitas” (i.e. A. phalloides (figure 1), A. bisporigera (…
Here are the highlights from the 2012 ACEP Clinical Policy regarding Critical Issues in the Initial Evaluation and Management of Patients Presenting to the ED in Early Pregnancy: The initial quantitative BhCG level does not help to distingu…
This may be surprising to many of you, but some of our patients abuse medication. In addition to Dilaudid, morphine, and Percocet, lets add topical ophthalmic anesthetics such as tetracaine to our “red flag” list. The most common offender…
Extracranial internal carotid artery dissection can cause ischemic stroke by thrombus formation or thromboembolism and subsequent arterial occlusion. In fact, it is the 2nd most common etiology of strokes in patients younger than 45 years….
We’ve all heard that lidocaine buffered with sodium bicarbonate makes the local anesthetic closer to physiologic pH. This in turn decreases time of onset and infiltration pain. However, upon further investigation, this may not be so true….
When negotiations break down with an undifferentiated agitated patient, before you reach for your trusty 5:2, consider ziprasidone (Geodon). Martel et al. concluded that droperidol or ziprasidone achieved better sedation of the undifferenti…
Herpetic Whitlow – Viral infection of hand caused by inoculation of HSV into broken skin Hand pain disproportionate to clinical presentation Associated with influenza-like illness Clear vesicles coalesce and become purulent but…
We love our lactates and want to protect them from every slip and fall. But are they a bit more resilient than we think? Jones et al. concluded that point-of-care venous lactate in healthy patients does not significantly change over a cour…
Interpreting head CT’s can be daunting. But it doesn’t have to be. Just remember, “Blood Can Be Very Bad”. Blood – blood up to 1 week old looks hyperdense to brain – blood 1-4 weeks old looks isodense to brain…
Consider giving 2mg of lorazepam to your patient who’s back at baseline after one alcohol withdrawal seizure to possibly prevent recurrent seizures. This may even save you an admission as long as the patient has been at baseline without si…
