Lumbar Puncture: the aftermath (aka how do i label the tubes?!)

Alright, you did it. LP complete! You look at those crystal clear tubes, and say to yourself…. “Ohhh yeah, champagne tap!” But then…you realize you ordered 9000 tests on these few drops of precious fluid and have no idea how to correctly ship them off to the lab. First, you ask around. No one seemsRead more

Thunderclap headache, but negative CT: now what?

A 45 year old male comes into the ED with a sudden, severe headache. It started while he was at work yesterday and was the worst of his life. It started feeling a little better, but hasn’t totally gone away and his wife made him come to get checked out. There are enough concerning featuresRead more

Renal Colic & the CT scan: flip your patient prone!

A CT abd/pelvis without contrast is one of our go-to studies when evaluating for nephrolithiasis in a patient with acute flank pain. And it’s a really good one too–a recent meta-analysis of CT for suspected renal stone showed a sensitivity of 97% and a specificity of 95%. Pretty, pretty excellent. But have you ever wonderRead more

Street Stats: The Bonferroni Correction

Tl;dr: (1) Expected false positive rate for any one statistical test is generally 0.05 (aka, alpha). But this error compounds when you run multiple statistical tests. (2) Adjust your target p-value by applying the Bonferonni correction (0.05/n where n = # statistical to tests) to see if authors’ findings are truly consistent with their reportedRead more

Core Content: Critical actions for the preeclamptic patient

Tl;dr: (1) Don’t forget to order a uric acid with the labs as it increases the specificity in diagnosing preeclampsia. (2) If the pt is preeclamptic with severe features (see below), then give 4g IV Mg followed by 1-2gr/hr infusion for 24hrs. (3) Unlike other hypertensive emergencies, start with push dose meds rather than ourRead more

Difficult placement of an OGT? Try an ET tube introducer

Tl;dr: Failed OGT placement in an intubated patient is common. Try using an 8.0 ETT as an introducer into the esophagus to prevent coiling in the mouth / upper esophagus.   Placement of an OGT or NGT can often be challenging in an intubated patient since we can’t ask them to swallow during the procedure.Read more

Applying the Pelvic Binder: Pearls and Pitfalls

Tl;dr: (1) Never rock the pelvis. Firmly squeeze and hold. (2) Consider quickly assessing for rectal or vaginal bleeding prior to binder application as this would suggest an open fx into the vag / rectal vault. It will be difficult to complete the exam once the binder is on. (3) The binder is applied overRead more

Don’t Be Rash

Do you ever have a patient with a rash you just don’t recognize?  If you’re like me, it happens all the time and it can be hard to organize your differential.  Michelle Lin ( published a great set of differentials for the dangerous rashes that I think might make this less garbled and difficult. AGE <5: Meningococcemia,Read more

Buprenorphine Band Wagon

Do you know David Cisewski?  He’s incredible and he’s written an incredible review on buprenorphine ( that I’d like to tell you all about. Buprenorphine marketed as Suboxone (but soon to be generic) is a mu-opioid receptor partial agonist that will fulfill cravings for opioids and suppress withdrawal symptoms, but also has a “ceiling effect” that makes abuseRead more

Ultrasound and Found

Ultrasound for kidney stone has always been confusing.  If we do the ultrasound and find no hydro, don’t we need the CT to rule an alternate diagnosis?  If we do the ultrasound and find hydro, don’t we need a CT to see if the stone would be too large to pass?  While these questions still haunt me,Read more