Ultrasound Guided Subclavian Central Lines

Of the three primary locations for central line placements, most EM residents seem to be least well-versed in the now rarely placed subclavian central line. The feared complication of pneumothorax steers many doctors to other locales. But there is a time and a place for everything, so knowing how to improve your chance of successfullyRead more

EMTALA for Dummies

What is EMTALA? EMTALA stands for “Emergency Medical Treatment & Labor Act.” It is a federal law enacted by Congress in 1986 to prevent hospitals from sending away patients based on insurance status, race, gender, national origin, preexisting medical conditions, etc. It was developed in response to public outrage about reported cases of private hospitalsRead more

Colic Like You See It: Pain Control for Nephrolithiasis

Many clinicians hold that good pain relief with NSAIDs of patients with flank pain should further your suspicion of nephrolithiasis as the etiology. This effect is reportedly due to a decrease in  ureterospasm and decreased in GFR leading to reduced renal capsular pressure in the obstructed kidney.  Still, many prior trials have had mixed resultsRead more

When the IVC Runneth Over: Ultrasound Assessment of Fluid Responsiveness

Tanking up the volume-depleted hypotensive patient requires a fine balance between under-resuscitation and the pulmonary edema of overdoing it. “Dynamic” measures of fluid responsiveness are technically complex and likely inaccessible to most ED physicians,  so consequently much research and discussion has offered ultrasound techniques of varying degrees of complexity for assessing volume status. Here’s aRead more

You and the Cap’n Make It Happen

Can’t get that posterior hip location back into place? Don’t have enough collective muscle in the ED to just brute force the thing to where it belongs? Then leverage the power of simple mechanical advantage and utilize the Captain Morgan technique of hip reduction. Pop that femoral head back into the acetabulum by popping yourRead more

Acute Heart Failure Diagnosis in ED

  Many ER residents have found themselves justifying an admission of an acute or decompensated heart failure patient to a skeptical admitting resident. For better or worse, the skepticism is not without reason; an initial ED admission diagnosis of AHF (acute heart failure) in ED is discordant from final discharge diagnosis in about one outRead more

Using the LUCAS Device

So how do you use that big fancy LUCAS machine? Pretty easy actually, but worth knowing before your arresting patient arrives. 1) Position the machine on the patient: Put the yellow back plate under the patient; this should be neatly centered behind the patient’s sternum to facilitate accurate application of the suction cup. Now clickRead more

(de) Winter’s Coming

  Want to read an EKG like a 3rd year med student? Recognize ST elevations. Want to blow your attending away with your savant-like EKG mastery? Start learning all the myriad STEMI equivalents. For today: the de Winter’s T-wave. What is it? Up-sweeping ST-depression and symmetrical peaked t-wave in pre-cordial leads (see below) What doesRead more

Keep All Five Boroughs in Stitches

  Looking to up your lac repair game? With a simple modification, the old dependable horizontal mattress stitch can be transformed into the notably improved and versatile modified locking horizontal mattress stitch. This stitch provides nice wound eversion, fine approximation, and easier removal. For EM physicians, the technique can also be used for achieving hemostasisRead more

What We Learned at CORD16

Missed CORD? Here are a few take home thoughts from @BenAzan and @NupurGargMD. This is by no means meant to be comprehensive, but represents the learning points of a couple of senior residents at CORD. – Education – Career in Academics:  Strive to get where you want academically BUT don’t necessarily to have I keep going up hierarchy to be happy –Read more