Sepsis 2.0 vs 3.0

A 65 yo M is bibems tachycardic and hypotensive with one week of worsening cough and sob.  Large LLL infiltrate is present on XRay.  You begin treating your patient for severe sepsis and begin to wonder what has been happening in the world of sepsis recently. October 1st, 2015: CMS published a new sepsis bundleRead more

LVADs for Emergency Physicians

This pearl is based off a question on our in-service yesterday.   You are working resus and a 63 yo M presents with altered mental status. He has a LVAD. His EKG is below: Time to call the LVAD team right? Well what if you can’t reach them or you receive this patient in aRead more

Unstable Cervical Fractures

Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.   Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures   Jefferson Fracture A burst fracture of the ring of C1 Typically caused by an axial loading force to the occiput (think diving injury) TypicallyRead more


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 does not want to die.  As your nurse is drawing labs yourRead more

Arntfield on TEE

We miss having Rob in NYC, but he has certainly hasn’t been slacking off in the depths of Ontarian Polar Vortices.  Here’s the latest from London on Arntfield’s ED TEE protocol.Read more

A Novel Idea for Airway Management

A 65 yo M is rushed into the resus room. He is pale and is vomiting a mixture of coffee ground emesis and bright red blood. His vitals are stable currently but he is continuing to vomit in the emergency department. This patient requires a definitive airway. You have studied the emcrit guidelines for intubatingRead more


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 with a little blue angiocatheter and a little pieceRead more

Not quite a STEMI

ST elevation gets all the attention when discussing EKGs. We have special STEMI and C-port alerts making it particularly sexy. Everyone knows to look for STEMI and how to manage it (aspirin, +/- Plavix load and straight to cath lab). However, we cannot forget about other important critical EKG findings that manifest themselves with ST depressionRead more

LLQ abdominal pain

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 pelvis shows diverticulitis without evidence of abscess or perforation. Time to pullRead more

HIV-Related Heart Disease

CAD and ACS: Both HIV and anti-retroviral medications increase patients’ risk of cardiovascular disease HIV-infected patients tend to have a first episode of ACS at age 48 yrs, 10 years earlier than HIV negative patients Reasons for increased risk include higher rates of smoking in HIV+ patients (2-3 times greater than in general population) andRead more