Hypertonic Saline

In patients with active or impending herniation and deterioration, 23.4% Normal Saline has been shown to be beneficial. It can only be administered through a central line. The current recommended dose is 30mL which must be given slowly over 10-30 minutes while patient is actively hyperventilated w/ rate >40 and the physician looks for signsRead more

Us Guided Subclavian Line

There was a study published on the Journal of Critical Care Medicine in July 2011 comparing US guided vs landmark approach to subclavian vein central line placement.  In the study, “subclavian vein cannulation was achieved in 100% of patients in the ultrasound group as compared with 87.5% in the landmark one.”  The ultrasound group alsoRead more

Retrograde Bougie Intubation in Patient W/ Tracheostomy

In a patient w/ a trach who is now hypoxic and/or the trach is malfunctioning a bougie may potentially be passed through the trach directed cephalad, once the provider who is at the head and performing direct laryngoscopy is able to visualize the bougie he may “grasp” it w/ a clamp to pull it outRead more

Where’s the Cuff?

After intubation, a quick and easy way to estimate ET tube position is by palpating the sternal notch and feeling for the ET cuff.  By holding on to the pilot balloon (balloon used to check if cuff is inflated) and palpating on the sternal notch you should be able to feel the pilot balloon distend ifRead more

Hertz so Good – Sonogames 2014

Congratulation, Raashee, Jeremy and George, Sinai’s team “Hertz so Good” finally made it past the first round, finishing seventh out of thirty-six teams!! Raashee’s In-plane technique George Blind Scanning Jeremy providing remote telesonography guidance Sono charades Find the artifact – didn’t we just do this at the Hurst? Medals Jeremy shows off his medals TheRead more

I Can’t Feel a Pulse!

53 yo M w/ PMHx of HTN, CAD, and CHF s/p LVAD placement presents to the ED w/ c/o CP.  Patient reports he had mild CP overnight but this morning woke up with increasing SOB and severe CP radiating to his R arm.  He immediately called 911 and his RN coordinator.  Patient now in theRead more

Kill Billy; Volume 3

EMS calls in to the department and states they are en-route w/ an ETA of 5 minutes w/ an 8 yo M w/ no known PMHx in severe distress, no further history provided. 3 minutes later an 8 yo M is wheeled into the department by EMS, the child is obtunded, diaphoretic, and has bluishRead more

A Little Intoxicated…

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 abnormal odors.  He refuses to provide any history.Read more

Elderly Female with Complaint of Neck Pain.

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 changes, vague reporting of onset characteristic but could not recall exactRead more

Airway Basics

  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 in shock Propofol: 2mg/kg IV dose, shortest half-live, ideal in scenarios where neurologic exams may be required, sedation for EtOHRead more