Hypertonic Saline

In patients with active or impending herniation and deterioration, 23.4% Normal Saline has been shown to be beneficial. It can only be administered through a central line. The current recommended dose is 30mL which must be given slowly over…

Us Guided Subclavian Line

There was a study published on the Journal of Critical Care Medicine in July 2011 comparing US guided vs landmark approach to subclavian vein central line placement.  In the study, “subclavian vein cannulation was achieved in 100% of…

Where’s the Cuff?

After intubation, a quick and easy way to estimate ET tube position is by palpating the sternal notch and feeling for the ET cuff.  By holding on to the pilot balloon (balloon used to check if cuff is inflated) and palpating on the sternal…

I Can’t Feel a Pulse!

53 yo M w/ PMHx of HTN, CAD, and CHF s/p LVAD placement presents to the ED w/ c/o CP.  Patient reports he had mild CP overnight but this morning woke up with increasing SOB and severe CP radiating to his R arm.  He immediately called 911 an…

Kill Billy; Volume 3

EMS calls in to the department and states they are en-route w/ an ETA of 5 minutes w/ an 8 yo M w/ no known PMHx in severe distress, no further history provided. 3 minutes later an 8 yo M is wheeled into the department by EMS, the child is…

A Little Intoxicated…

23 yo M w/ no known PMHx presents to the ED BIBEMS for AMS.  Patient is awake but appears slightly confused, he is salivating and spitting in the ED but able to protect his airway and his vitals are stable, he has no signs of trauma, no abn…

Elderly Female with Complaint of Neck Pain.

Elderly female w/ PMHx of TIA, DM, and remote breast Cancer history reportedly in remission presented to the ED w/ c/o R-sided neck pain radiating to her R trapezius for 2 days.  No fevers or chills, no Hx of trauma or falls, no vision chan…

Airway Basics

  For Patients in Cardiac Arrest use LMA until there is ROSC and situation under control   Induction Agents Etomidate: 0.3mg/kg IV dose, “cardiac Stable,” unclear effect if dose decreased, may not be ideal for patients…

I Think My 17-month-old Baby is Drunk!

17-month-old F w/ no sig PMHx presents to the ED accompanied by her mother who is concerned because her baby is “acting drunk.” Mother reports child was staying with grandparents over the weekend and today began “walking f…

Interesting Case of Facial Swelling

  Interesting Case of Facial Swelling. 55 yo F w/ PMHx of HTN, DM, and ESRD on HD presented to the ED w/ c/o facial redness and swelling progressively worsening for 3 days. Patient  discharged 7 days prior from outside hospital but una…

May 2014
M T W T F S S
 1234
567891011
12131415161718
19202122232425
262728293031  

Archives