D-dimer for dissection?

Aortic dissection continues to be one of the most difficult diagnoses to make. The IRAD study from 2009 found that a d-dimer <500 ng/mL used to rule out acute aortic dissection had a negative likelihood ratio of 0.07 in the first 24 hours, with a sensitivity of 96.6%. Check out the study here.  In termsRead more

Nasal Foreign Body

Nasal foreign bodies present with a wide variety of complaints ranging from history of insertion without symptoms (71-88% of patients), mucopurulent nasal discharge (17-24%), foul odor (9%), epistaxis (3-6%) to mouth breathing (2%). Most commonly, foreign bodies are located under the inferior turbinate on the nasal floor or in front of the middle turbinate. ForeignRead more

Broken tooth? Don’t break a sweat

Summertime brings us all sorts of playground, sports and even graduation party injuries. Injuries to the teeth, though not usually life threatening, can often make us uncomfortable. Next time you approach a patient with a dental injury, remember the Ellis system of classification system for a tooth fracture. Ellis 1: injury of the crown intoRead more

A Head’s Up about Head Trauma

The World Cup is on! Every four years, the beautiful game moves the big stage where we get to see the sport played at its finest. We also get to see the slide tackles, the dives and, more concerning, the head injuries…even if voluntary (see above). Let’s take this moment to review traumatic brain injuryRead more

Central line complications? You thought you knew them all…

Today we have a guest Pearl writer, our very own rising PGY2 Arjun Prabhu. He learned about an interesting complication while at a committee meeting and wanted to share: You are getting set up for a femoral central line in resus and are thinking of the possible complications while you’re getting things together. You don’tRead more

Don’t Fear the Tracheostomy

Imagine you’re in resus, juggling your many sepsis patients, when a patient is rushed into the room. All you hear is “trach problem.” Before you jump to the AMAC > ENT pathway, think about this simple outline. There are 3 main trach emergencies and 3 major things you need to know. Read below for anRead more

The reason you’ve been carrying that scalpel in your scrub pocket…

As ED physicians, we fear the patient we can’t intubate, can’t ventilate. We’ve had a rash of emergency cricothyrotomies in our ED recently. Though rare, you never know when you might need to perform this life saving procedure. Review the brief overview of the steps of the procedure below so you’ll be ready to stepRead more