By Lara Silverman, MD/MPH Emergency Medicine PGY3 Pressors are used in hypotension. Per Scott Weingart, there are three main reasons we use pressors: Maintain critical perfusion pressors, especially to the brain, heart, and kidneys. B…
Why Paxlovid: According to Pfizer’s clinical trial data from 2021 (participants enrolled by 09/29/2021) which it used for FDA approval, subjects who took Paxlovid were 89% less likely to develop severe illness and death from COVID than thos…
Remember MONA (morphine, oxygen, nitro, aspirin) from med school? Well, she may be just “A” now…. Over the years, all of these treatments (except for good old aspirin) have become somewhat controversial in the treatment of ACS. Let’s focus…
Have you ever taken care of really critical, undifferentiated patient, only later to find out that they were diagnosed with a serious, contagious illness? We are exposed to innumerable pathogens each day in the ED, but there are only a few…
“If there’s a pill, then pharmaceutical companies will find a disease for it.” – Jeremy Laurance A recent study conducted at an urban health care center (Friedman et al. 2017) compared outcomes for diazepam in conjunction…
Have you ever had those patients that are agitated? In a Zombie-like frenzy they rip out all their lines and extubate themselves in the CT scanner agitated? I think we’ve all been there (hopefully with something for sedation in hand!)…
The use of vasopressors and inotropes to treat hypotension is common in the emergency department. It is now standard to start off with norepinephrine as your 1st line agent to treat shock in the ED. But is norepi always that best choice?…
This pearl was created in light of our impending in-service exam this Wednesday. Hopefully reading this will give you at least 1 point on the exam. A 19 yo F ingested 150 pills of Tylenol four hours ago and is presenting now because she do…
You are working resus at 2 am when EMS rolls in with a 60 year old patient with fever and cough, hypotensive to 83/40 with a HR of 142. This septic patient needs emergent fluid resuscitation. You notice the RN about to place a peripheral IV…
A 43 yo M presents with LLQ abd pain, non-bloody diarrhea and subjective fever for 1 d. His vitals are normal, has a WBC of 14 but otherwise normal labs. He is given IV analgesia and clinically has improved, tolerating PO. CT abdomen and…
Status epilepticus is one of the few neurologic emergencies. Many protocols for persistent status involve dosing with a benzodiazepine, then another benzo, then an antiepileptic medication, and finally, continuous sedation with intubation….
What do you think?
A 24yo M with hx schizophrenia presents to the ED agitated, threatening staff and making gestures of self-harm. You are unable to verbally deescalate him and go to order some sedative medication. However, on his chart you see “Allergy: ha…
A recent double-blinded, RCT from JAMA investigated the relative efficacies of naproxen + placebo, naproxen + cyclobenzaprine and naproxen + oxycodone/acetaminophen on functional impairment in acute onset (<2 weeks), non-traumatic, non-r…
Asking an anesthesiologist or EM doc their choice of paralytic can spark heated debate. What do you prefer? Succinylcholine: -depolarizing agent -30-60 sec onset -8-15 min duration -adverse reactions: bradycardia, hyperK, fasciculations, m…
