Turn off That Alarm!

You’re peacefully writing a note when you notice an incessant beeping from the back of your resus bay.  It’s not a monitor, it’s a ventilator.  What do you do? Press the silence button?  Call respiratory therapy? As Dr. Weingart has said, v…

Elevated Lactate in Asthmatics

You’re treating an asthmatic 22-year-old.  You give 5 back-to-back nebs, steroids and mag.  When you reassess, she’s moving air better with minimal wheezing, but more tachypneic.  Additionally, her lactate has climbed from 2 to 6.8 in 2 hou…

That “Dirty” ED Line

Do central line-associated bloodstream infection (CLABSI) rates differ based on whether they were placed in the ED versus the ICU? A recent article published in Academic Emergency Medicine attempted to answer this very question. Central lin…

The Forgotten Lead

aVR is the neglected cousin of the other ECG leads. He doesn’t always make sense, nobody really understands him, and he usually sits alone at the dinner table. This is to the detriment of those who ignore him, as aVR can easily lead clinici…

Subarachnoid Hemorrhage Revisited

Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency…

Choosing the Best Test

Today’s pearl is short and sweet. Here’s a breakdown of common radiologic studies performed in the emergency department along with their sensitivities and specificities according to the available literature. You may be surprised by so…

To Buffer an Acid You Add a Base, Right?

What do you do if your septic patient now has a lactate of 12 and a pH of 7.00? You’ve already started your fluids, antibiotics, pressors, and have ruled out any unaddressed source. Intuitively, your patient’s acidosis should be corrected b…

A Modified Valsalva for Svt

Although clinical practice may differ, vagal maneuvers are still the first step in attempting to convert supraventricular tachycardia (SVT) to sinus rhythm prior to adenosine. The reason why they are rarely attempted is because of relativel…

Arytenoid Cartilage Dislocation

Your patient with respiratory failure was successfully intubated and admitted to the MICU. Two weeks later he comes back to the ED complaining of persistent hoarse voice and dysphagia. He states he was extubated 1 week prior and was told hi…

October 2015
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