Expressing Empathy in the ED

Have you spent the past week wondering how you could express empathy more successfully? Don’t re-invent the wheel, use a tool from palliative care — NURSE statements! Name the emotion: “Many people would feel angry if that happened to them, I wonder if you have felt that way?” Understand the emotion: “Although I personally haveRead more

What to do with a metabolic kid

Ornithine transcarbamylase deficiency, citrullinemia, methylmalonic acidemia, tyrosinemia, phenylketonuria, Galactosemia… did I lose you yet? These words bring me back to the dark place of step one studying. So take a deep breath, don’t worry about the big words and here are a couple of tips next time you have a “metabolic kid” in the pedsRead more

Naloxone — a how to

Have you ever tried to figure out what the appropriate starting dose of naloxone is? When you dig in the literature it’s pretty clear that its a lot of hand waving and muddy water — but let me give you an approach and some of the literate that is out there Apneic patient: 1-2mg naloxoneRead more

Remind me again about neonatal jaundice??

I have a new niece, Kaitlyn Marie, who is just crushing life so far, but my brother called me and asked all about neonatal jaundice, so here is some info to help you the next time you see this in the peds ED or someone you know calls you to ask. Why are babies atRead more

Start practicing your lung ultrasound

We know Jim Tsung can ultrasound anything, but in the peds world we all need to beef up our lung ultrasounds because more and more evidence is piling up to support the use of ultrasound to diagnose pediatric pneumonia. A recent meta-analysis of 1510 patients showed that lung ultrasound had a sensitivity of 95.5% (93.6-97.1) andRead more

Know about NO?

Consider inhaled nitric oxide in massive PE and watch for upcoming literature. Massive PE elevates pulmonary vascular resistance leading to right ventricular failure, hypoxemia, and cardiogenic shock. Inhaled nitric oxide selectively dilates pulmonary vasculature and has antiplatelet activity. Prior case series show improvements in oxygenation and hemodynamic variables within minutes of starting iNO. How does iNO help?Read more

Take Pride in the Para

Ever been annoyed when you try to admit a liver patient and the MAR requests that you perform a diagnostic tap prior to admission? Here is the data behind why we perform diagnostic paracentesis in the ED. Bottom line: performing diagnostic paracentesis in hospitalized patients early is associated with improved mortality.  There are a few importantRead more

The next shoulder dislocation you see….

Try an interscalene block! It anesthetizes C5-7 and is used in shoulder surgery- surely that is good enough for a measly little reduction. Studies in the ED have shown decreased time in the ED and good anesthesia for shoulder reduction. Here is how: Place patient in supine position Using the linear ultrasound probe oriented likeRead more

Doubt Aortic Dissection?

Don’t want to read more? Here is the summary: There are a bunch of studies coming out looking at risk stratification for Aortic Dissection (AD). On chest pain patients check for focal sensory/motor neurologic deficit, pulse deficit and hypotension and look for widening of the mediastinum on CXR. Aortic dissection detection score + d-dimer canRead more

Your guide to steroids in septic shock

Ok, so you know there is controversy in the use of steroids in septic shock, but what does the data actually support in terms of when you should and should not use them — here is a guide! Don’t want to read more? Here is the jist: Steroids (hydrocortisone <400mg/day) may reduce time in shockRead more