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“Trust, but verify” -Ronald Reagan   Why would you need ultrasound for tube confirmation? You can confirm placement with direct visualization (sometimes video laryngoscopy), use end tidal CO2, look for color change on colorimetric capnography, listen for bilateral breath sounds, check pulse oximetry, and look for fogging in the tube. In most cases, these methodsRead more

“I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.” – Rocky Graziano   Article Citation: Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul;260(1):93-101. PMID: 16789984   What weRead more

“If there’s a pill, then pharmaceutical companies will find a disease for it.” – Jeremy Laurance   A recent study conducted at an urban health care center (Friedman et al. 2017) compared outcomes for diazepam in conjunction with naproxen against naproxen alone for acute, non-traumatic, non-radicular lower back pain. For lower back pain, common treatmentRead more

“The role of a clown and a physician are the same – it’s to elevate the possible and to relieve suffering.” -Patch Adams   Do you regularly raise the head of the bed when you intubate? Well, maybe you should!   A recent manuscript in the American Journal of Emergency Medicine (Turner et al. 2017)Read more

Don’t forget to consider Fitz-Hugh-Curtis Syndrome in your right upper quadrant pain differential!   Fits-Hugh-Curtis Syndrome is a rare disease process characterized by perihepatitis as a complication of pelvic inflammatory disease (PID). Patients usually present with severe and sudden onset pain in the right upper quadrant. Movement will typically worsen the pain. The patient mayRead more

“There is nothing like the cure of fresh air for cases of bladder infection, paranoia, and Cartesian thinking.” -Rawi Hage   Title: “The 52 in 52 Review: Noninvasive ventilation in acute cardiogenic pulmonary edema”   Article Citation: Masip J, Roque M, Sánchez B, Fernández R, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematicRead more

“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.” -Kailash Satyarthi   Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not useRead more

Clinicians often consider alternate imaging modalities over contrast studies due to concern of acute kidney injury. In many situations, intravenous contrast can significantly improve the utility of a study. So, is contrast-induced nephropathy real? How often does acute kidney injury occur after a contrast study?   A recent study (Hinson et al. 2016) did aRead more

The short answer is that it might. While it may not be surprising to you that ED crowding is detrimental to overall patient care, it may surprise you that it could be linked to inpatient mortality. At least a few studies have been looking in that direction.   A 2013 study with almost 1 millionRead more

“Ventilation is the profound secret of existence” – Peter Sloterdijk   Article Citation: Brochard L, Mancebo J, Wysocki M, Lofaso F, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995 Sep 28;333(13):817-22. PMID: 7651472   What we already know about the topic: Noninvasive ventilation is an often usedRead more