Spontaneous Pneumomediastinum

Posted on by Monica Sethi

Your patient is a 24 yo M with chest pain.  It is pleuritic. He has normal vitals and you’re not too concerned. You get a CXR and you see the result in this post. He has pneumomediastinum! What is that? What do I Do now? Spontaneous pneumomediastinum is rare, occurring in approximately 1 in 30,000 […]

In flight emergencies and when to land the plane

Posted on by Hayley Neher

You are on a flight, halfway across the Atlantic Ocean at the start of a much needed vacation, binge watching that new show everyone has been talking about but you’ve never had time to see.  Suddenly, the screen freezes and an overhead announcement interrupts your zen-like, screen-induced partial stupor.  “Is there a doctor on board?” […]

PE risk stratification: which tool is best?

Posted on by Hayley Neher

  Your patient with a newly diagnosed PE hates hospitals.  He or she agrees to defer to your judgement about admission versus discharge home, but makes it clear they would prefer to go home if it is safe.  Which tool should you use to help you decide? Up until recently, there were no prospective studies […]

Proper cane use

Posted on by Hayley Neher

We give out canes like they’re candy.  But are we doing a good job adjusting the cane and teaching patients how to use them?  Canes that are not the right height for your patient or are being used incorrectly can put patients at an even greater risk of falls.   The proper height can be […]

Do antivirals or steroids help make shingles better?

Posted on by Hayley Neher

A patient comes to the emergency department reporting a few days of excruciating pain in a band around his right chest.  Today, he developed vesicles over the same area which prompted him to come in.  Classic shingles.  Like most patients diagnosed with this disease, he is sent home with wound care, return precautions, contact precautions, […]

Double Sequence No-no???
Posted on by Hayley Neher

  You are the leader of the code team.  Your patient is in refractory VF after multiple rounds of shocks and drugs.  You’ve tried repositioning the pads into an anterior-posterior position.  Looking around, you ask for suggestions.  Someone suggests double sequence defibrillation.  After all, what’s the harm?   Sorry to take away one of your […]

Sedation Drugs
Posted on by Hayley Neher

  It’s 1 am and things are winding down.  The trickle of patients has slowed and it actually looks like you and your team are catching up.  Suddenly, you hear yelling, swearing and crashes coming from triage.  Other patients are looking around to see what is going on.  The sound of the triage nurse comes […]

Nose spray and hemodynamics
Posted on by Hayley Neher

Ah, cold and flu season.  It’s that joyous time of year when our department is flooded with miserable people complaining of sinus headaches, rhinorrhea and feeling terrible.  We all know that for most viruses, symptomatic care is the way to go.  A nose spray would be helpful, but what about all of those warning labels […]

Penicillin Allergy and Superbugs
Posted on by Hayley Neher

  Penicillin allergy is a common finding in many patient charts.  Sometimes it can be difficult to figure out who, when and why this label was added to a medical record.  Sometimes patients themselves perpetuate the label, unwittingly reporting something a parent told them about a possible reaction as a child, or mistaking side effects […]

Probiotics. Use them. Love them.
Posted on by Hayley Neher

We all prescribe antibiotics frequently.  While the debate about who is contributing more to the terrifying antibiotic resistance patterns and the emergence of superbugs rages on, we can sometimes forget or minimize the fact that antibiotics have immediate side effects for our patients.  Serious and seriously unpleasant side effects.   A publication in JAMA from […]

Doc, I have this burning sensation…
Posted on by Hayley Neher

  For many of our patients, frequent UTIs can be a big source of discomfort and frequent ED or PMD visits.  Women, in particular, are impacted by this issue as they have >50% lifetime risk of acute cystitis.  Many are treated with antibiotics which may or may not be appropriate (don’t worry, that is a […]

Santa is Real. Here’s Proof.
Posted on by Hayley Neher

Just kidding.  Happy Holidays, kids.   Follow Santa on his magical trek around the world: https://santatracker.google.com/village.html   Bonus: Want to know more about the Dreidel? https://www.chabad.org/holidays/chanukah/article_cdo/aid/597253/jewish/How-to-Play-Dreidel-Sevivon.htm

Lidocaine drip, but not what you think
Posted on by Hayley Neher

The practice of using EMLA or LET cream on a wound that is about to be cleansed, explored and sutured is common, especially in the PEDs world.  However, both of these options take time to work, which can be a significant barrier to use during a busy shift. A paper published in October 2018 (see […]

Concussion Recovery in Children
Posted on by Hayley Neher

An otherwise healthy 11 year old boy is brought to the ED by his parent after “hitting his head pretty hard” during hockey practice.  The child was “out of it” for a little while but did not lose consciousness.  He seems foggy, complains of a headache and asks to turn off the lights.  You diagnose […]

Doc, what if my head explodes?
Posted on by Hayley Neher

It’s a busy Monday afternoon.  Patients are packed into the department like sardines.  You have bruises on your shins from trying to wade through the stretchers to discharge a few people, but now you’re back at the computer ready to pick up some new ones.  You click on the next person waiting to be seen, […]