Skin Not Tough Enough?

Steri-strip and Suture Combo Technique for Repairing Fragile Skin   Old people.  They come with all sorts of problems and complications. Even simple lacerations are more complicated with them. Have you ever encountered a laceration in…

How deep should I place my CVC?

All the hard parts are done in the placement of your central line. You nicked the vein and NOT the artery. The wire threaded smoothly. You got confirmation on your ultrasound. Now, you just insert the triple lumen in over the wire. Insertin…

The Ten Commandments

Verbal de-escalation is a powerful and effective skill to help calm agitated and aggressive patients. This method is proven safe, effective and decreases the likelihood for restraints. Among properly trained physicians this process takes le…

Sugar the Rim

“Want to hear the funniest therapy that actually works?” – Dr. Ben Schnapp, former Chief Resident extraordinaire [spacer height=”20px”] It was my first month of intern year, and I had just presented a patient w…

I hate Mondays!

Garfield had it right. Mondays are the worst.  [spacer height=”20px”] Want proof? Well, in 2004 the CDC published a survey measuring health care utilization among US Emergency Departments over a 10 year period. The results? ED v…

Name that plethoric structure…

We are all familiar with the RUSH exam (see Dr. Weingart’s original article if you’re not). Since it’s been a recurring theme this week, we are going to focus on the IVC measurement of the spontaneously breathing patient. This will not be a…

DKA without the ICU

As we discussed yesterday, the treatment algorithm for DKA is fairly straightforward with a few subtleties we rarely appreciate, until now. Yesterday we focused on fluids, today we move on to the insulin. Can we offer the patient anything e…

Diluting your sugar

Last week, we closed out the week by discussing the dischargable, ‘benign sugars,’ but what about when you have the legit ‘sugars.’ We’re talking about DKA. While the algorithm for DKA is fairly straight forward – fluids, insulin, replete l…

The oft forgotten ‘centesis

Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis: Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion Contraindication…

ROID RAGE Pt 2

If yesterday’s post on Roids didn’t get you jack’d then maybe today’s will! Here’s part deuce – Topical Steroids Spoiler alert – if you are using 1% hydrocortisone for every rash everywhere then you…

August 2016
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