Feeling the burn: Burn care in the ED

I can count the number of severe burns I’ve seen in residency on one hand. I suspect that’s true for many of us, especially if you don’t work at a burn center. The problem is that these patients can be really sick and require a lot of urgent management. So today we’re going to discussRead more

Aint got time to bleed part 2: Lumbar Puncture and Anticoagulation

Often in the ED we are faced with a patient who is on anticoagulation and needs an urgent procedure. Lumbar puncture is a very safe procedure overall, but it’s particularly dicey in the setting of anticoagulation because of the possibility of spinal hematoma and subsequent neurologic sequelae. Let’s take a look at what the guidelinesRead more

Tips for being a pro lineman: central line edition

Today we bring you a compilation of several tips to make your next central line go more smoothly. Interns and 2nd years will probably find these tips most useful, but you’d be surprised how much you can pick up even as you get further on into residency. 1. Prepare your own sterile flushes.  If you’reRead more

ASE President supports Point of Care Ultrasound

There is no denying that if I were to suffer a sudden hemodynamic collapse and would wind up in an emergency department, I would want it to be one in which the emergency physicians were fully trained in POCUS (point of care ultrasound) and knew how to apply it to patient care. – Susan Weigers,Read more

EKGs you don’t know: de Winter’s waves

Chest pain: the bread and butter of emergency medicine. We see so many of these that it can be mind-numbing, and for EXACTLY that reason it’s critical to recognize those weird EKGs that aren’t an obvious STEMI but can signal a coronary occlusion. One of the less-talked-about danger signs on EKG is “de Winter’s waves“,Read more

Salicylates, they can really go to your head.

Salicylate toxicity has a long history of causing morbidity and mortality in ED patients. Historically there has been a decline in the number of cases of salicylate poisoning due to concern regarding Reye’s syndrome. However, in recent years worries have spurred a public health campaign to spread information regarding the risks of poisoning by theRead more

Stones in bad places!

A Trichobezoar A 45 year-old female with hx of anemia presents to your ER complaining of 2 days of abdominal pain with nausea and several episodes of dark emesis but otherwise conversant and non-toxic in appearance.  She has not passed stool or flatus for 1 day.  She reports that she recently felt fatigued and tooRead more

Ain’t got time to bleed: what to do about high INRs

Let’s say you’re seeing a 65-year old guy who is coming in for cough, and malaise. Plus, he was recently diagnosed with atrial fibrillation and started on coumadin, but hasn’t really been going to his appointments because he lives on the seventh floor and his daughter who usually helps him is on vacation. And he sometimesRead more

Perfecting your esophageal intubation

The hardest part of intubating your sick patient shouldn’t be the gastric tube. That’s what med students are for, right? Unfortunately, NG or OG tubes can be frustratingly difficult to place. A couple researchers from anesthesia have invented some ingenious techniques to get that slippery sucker right where it belongs. It’s worth noting that studiesRead more

EKGs you don’t know: bifascicular block

As ER docs, we see more EKGs per day than 95% of doctors out there. To survive, you have to be good at recognizing the big EKG findings, like STEMI, pericarditis, PE, and a multitude of arrhythmias. But if we’re honest, there’s always more to learn to pick up on the subtle things. In this post,Read more