M is for morphine

Remember MONA (morphine, oxygen, nitro, aspirin) from med school? Well, she may be just “A” now…. Over the years, all of these treatments (except for good old aspirin) have become somewhat controversial in the treatment of ACS. Let’s focus on morphine today. Morphine’s obvious benefit is its ability to control pain and therefore decrease sympatheticRead more

Meningitis Prophylaxis

Have you ever taken care of really critical, undifferentiated patient, only later to find out that they were diagnosed with a serious, contagious illness? We are exposed to innumerable pathogens each day in the ED, but there are only a few that necessitate antimicrobial prophylaxis and even fewer that require prophylaxis from simply being veryRead more

Does diazepam work for acute lower back pain?

“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

ED AGITATION: Let the Bodies Hit the Floor

Have you ever had those patients that are agitated? In a Zombie-like frenzy they rip out all their lines and extubate themselves in the CT scanner agitated? I think we’ve all been there (hopefully with something for sedation in hand!). Dr. Reuben Strayer highlighted how to handle these patients well in his 2016 SMACC talk.Read more


The use of vasopressors and inotropes to treat hypotension is common in the emergency department.  It is now standard to start off with norepinephrine as your 1st line agent to treat shock in the ED.  But is norepi always that best choice?   What if you need a second agent?   Treatment of hypotension shouldRead more


This pearl was created in light of our impending in-service exam this Wednesday.  Hopefully reading this will give you at least 1 point on the exam. A 19 yo F ingested 150 pills of Tylenol four hours ago and is presenting now because she does not want to die.  As your nurse is drawing labs yourRead more


You are working resus at 2 am when EMS rolls in with a 60 year old patient with fever and cough, hypotensive to 83/40 with a HR of 142. This septic patient needs emergent fluid resuscitation. You notice the RN about to place a peripheral IV with a little blue angiocatheter and a little pieceRead more

LLQ abdominal pain

A 43 yo M presents with LLQ abd pain, non-bloody diarrhea and subjective fever for 1 d. His vitals are normal, has a WBC of 14 but otherwise normal labs.  He is given IV analgesia and clinically has improved, tolerating PO.  CT abdomen and pelvis shows diverticulitis without evidence of abscess or perforation. Time to pullRead more

Status – but What if the Seizing Doesn’t Stop?

Status epilepticus is one of the few neurologic emergencies.  Many protocols for persistent status involve dosing with a benzodiazepine, then another benzo, then an antiepileptic medication, and finally, continuous sedation with intubation.  The Sinai protocol is found here. But what if the seizing doesn’t stop?  How long can we wait for these medications to workRead more

Is Papain Back for Food Bolus Management?

What do you think?Read more