A Bucket O’ Blood

You are taking a water break during your resus shift when you hear “clinical upgrade, acute zone 1”. You rush back to see a 60-year-old patient holding a bucket of bright red blood and you find out that he has an extensive PMH including HepC cirrhosis. After handling the initial resuscitation, you consider which additionalRead more

Status Epilepticus

Your patient arrives by ambulance having a seizure.  EMS administered ativan 10 minutes ago.  You give a second dose but the seizure continues.  What should you do?Read more

Interscalene Plexus Block

Your patient is a 25 year old male with a shoulder dislocation.  He needs analgesia, but has a date later and does not want to risk dimming his considerable mental acuity with systemic medications.  What to do?Read more

Opioid Induced Serotonin Syndrome?

What over the counter opiate derivative can induce serotonin syndrome? (and dissociation)Read more


You are managing an elderly patient with septic shock.  The ICU team is requesting ScvO2 measurement to be used in consideration of inotropic support.  You are not sure how to make decisions about inotropes based on ScvO2 and wonder:  What is ScvO2? what can it tell you?  what are its limitations? are there alternative measurementsRead more

Adenosine in the Management of Wide Complex Tachycardia

Your patient is stable but has wide complex tachycardia (WCT).  Your attending wants to give adenosine but you are unsure.  Isn’t there a chance this could lead to ventricular fibrillation?  In what circumstances is it safe to diagnose/ treat WCT with adenosine?Read more

Management of Intracerebral Hemorrhage Associated with Thrombolysis

One of your patients arrived with stroke and was treated with tPA.  On reevaluation the patient reports a new severe headache and then becomes lethargic.  What should you do?Read more

Pharmacological Treatment of Achalasia

Your patient is 54 years old, otherwise healthy, and presents with symptoms of achalasia.  He has a follow a up appointment with a gastroenterologist in one week but is having severe pain and regurgitation with meals and is not able to move up his appointment.  What can you do?Read more

Six of One, Half Dozen of the Other?

Your patient is a 50 year old male who presents with head trauma.  He takes aspirin daily.  Neuroimaging demonstrates subdural and subarachnoid hemorrhage.  You plan to treat with DDAVP and platelet transfusion.    When ordering the platelets you note that, whereas you are used to ordering a platelet “six pack,” the default order is forRead more

Procedural Sedation: Propofol or Ketofol?

    It’s Caturday night and you have a young, healthy male in your ED who dislocates his shoulder for the first time just 30 minutes prior to arrival. He seems like the purrfect candidate to perform a reduction without sedation, and you are paws-itive you can get the joint back in its place. YouRead more