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…
A) B) C) D)
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…
A 54-year-old suicidal patient presents to the ED after an unknown ingestion. Vitals are 98.9, 102, 18, 111/74, 97%, fs 98. She is somnolent but arousable. You send labs and find that the patient has an anion gap of 20, osmolal gap of 62…
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…
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…
I once lost a 25 year old on a cardiac shift. Later, after the shift ended, I was thinking of his whole life gone and wondering if I could have done more, performed more excellently. I wondered if another resident would have lost him if in…
“Lack of support in hospital/department. Social isolation, Lack of free time. Loss of confidence in your own abilities.” “…the fact that everything is on you…to push patients, to draw labs, to call consults, to juggle everything and have ex…
“I’m worried about losing my sense of humor…sometimes situations make me feel I’m losing that and then I’m just bitter.” “I actually think I’ve retained my compassion and empathy well…I think I have gained skepticism perhaps in exess of wha…
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…
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…
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…
The current Surviving Sepsis Campaign guidelines recommend starting either dopamine up to 10mcg/kg/min or epinephrine 0.05 mcg/kg/min for pediatric patients suffering from fluid-refractory septic shock. There is a significant lack of eviden…
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…
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…
