Turn off That Alarm!

You’re peacefully writing a note when you notice an incessant beeping from the back of your resus bay.  It’s not a monitor, it’s a ventilator.  What do you do? Press the silence button?  Call respiratory therapy? As Dr. Weingart has said, ventilator alarms need to be treated like a code announcement.  Immediate assessment is necessary.Read more

Name That Rash!

A)  B)  C) D) Read more

Elevated Lactate in Asthmatics

You’re treating an asthmatic 22-year-old.  You give 5 back-to-back nebs, steroids and mag.  When you reassess, she’s moving air better with minimal wheezing, but more tachypneic.  Additionally, her lactate has climbed from 2 to 6.8 in 2 hours.  She’s not hypoxic and there are no signs of hypoperfusion.  What gives? This patient has albuterol-induced hyperlactatemia. Read more

Toxic Alcohol Ingestions: What’s in the Gap?

A 54-year-old suicidal patient presents to the ED after an unknown ingestion.  Vitals are 98.9, 102, 18, 111/74, 97%, fs 98.  She is somnolent but arousable.  You send labs and find that the patient has an anion gap of 20, osmolal gap of 62, lactate of 8.8, ethanol of <10, and negative ketones. Q: WhatRead more

That “Dirty” ED Line

Do central line-associated bloodstream infection (CLABSI) rates differ based on whether they were placed in the ED versus the ICU? A recent article published in Academic Emergency Medicine attempted to answer this very question. Central lines inserted in the emergency department are often cited as being “dirty” or not having the same sterile precautions thatRead more

The Forgotten Lead

aVR is the neglected cousin of the other ECG leads. He doesn’t always make sense, nobody really understands him, and he usually sits alone at the dinner table. This is to the detriment of those who ignore him, as aVR can easily lead clinicians down the correct clinical pathway if used correctly. There are severalRead more

Wellness (July)

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Wellness Tip (August)

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Wellness Tip (October)

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When Was the Last Time You Cried over a Patient or Experienced a Strong Emotional Reaction?

I once lost a 25 year old on a cardiac shift. Later, after the shift ended, I was thinking of his whole life gone and wondering if I could have done more, performed more excellently. I wondered if another resident would have lost him if in my place.” “I had a woman in her 40s’sRead more