Meet the newest member of your team

We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know well these faceless interactions with a human reminding you to renally dose your Zosyn, stop ordering the bicarb drip that way…andRead more

Central Line Troubleshooting. Beyond the Basics.

Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease and a MAP of 50. Below are ten tips to help assist with successful line placement:   1) Manipulate the syringeRead more

Hurry Up & RUSH!

You’re working in RESUS, and you get a notification for hypotension. He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. You don’t see any signs of trauma. Your attending suggests performing a RUSHRead more

The Use of Haloperidol in Diabetic Gastroparesis

  Few would argue that Gastroparesis (or, delayed gastric emptying) is in the pantheon of coolest topics in EM these days, and for good reason. Affecting diabetics, chronic marijuana users, long-term smokers, this disease causes the unpleasant combination of chronic nausea, frequent vomiting, and abdominal pain. It’s difficult to treat, often refractory to our mostRead more

Inhaled Isopropyl Alcohol for Rapid Treatment of Nausea

You are quietly typing away at your computer when the familiar (but not entirely pleasant) sound of retching fills the air. You look out onto the side and see a young woman dry-heaving into a pink plastic bucket, looking miserable. This person will obviously need anti-emetics, but you know that 30+ minutes may pass beforeRead more

Hard Numbers and Blood Transfusions

Not infrequently we identify patients who need to have some sort of blood product transfused in the ER. Most of these patients are not crashing, and have time to have a formal conversation about risks, benefits, and alternatives to transfusion. Of course you know all of the risks associated with transfusion (you do know them,Read more

Ketamine for acute pain in the ED

Deaths from heroin rose to 8,260 in 2013, quadrupling since 2000 and aggravating what some were already calling the worst drug overdose epidemic in United States history. Overall, drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day. We’re aware that the opioidRead more

Absolute Lymphocyte Count as a Predictor of CD4

An HIV positive patient presents to the ED but doesn’t know his CD4 count. He hasn’t been taking his HAART and you’re rightfully concerned that he might be susceptible to opportunistic infections. Unfortunately, you can’t find any information about how immunosuppressed he is. Is there a way to estimate his CD4 count? Luckily, there is!Read more

Globe Subluxation

Apologies for the lack of recent pearls. Now that the website is back up and running, we’ll be going back to our regularly scheduled programming. “Hey doc, my eyeball popped out”. It’s a chief complaint that we don’t hear too often in the ED but when it happens, it’s enough to make me sweat aRead more

52 in 52: A Clinical Predictive Tool for Intra-Abdominal Trauma in Pediatric Patients

Title: Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma Article Citation: Holmes JF, Mao A, Awasthi S, McGahan JP, et al. Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med. 2009 Oct;54(4):528-33. PMID: 19250706 WhatRead more