You have a patient who is in acute renal failure. You have sent an ER-venous panel that shows a Cr of 4.6, a BUN of 95, and a K of 6.5. You discuss these findings with your nephrology colleagues who request you get the “more accurate” basic…
74 yo F with hx of CAD, afib, HLD, severe LV dysfunction is brought in by EMS as a notification for a STEMI. A 12-lead EKG in your ED shows the same as the EMS EKG. Should you activate the CATH lab? Answer: Check an old EKG. An old E…
So, you’ve just finished suturing an uncomplicated laceration and you think to yourself: should I apply antibiotic ointment or just cover with a bandage with good return precautions? Answer: There is some limited evidence to support…
Article Citation: Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, et al; DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003 Aug 21;349(8):733-42. PMID:…
There may be. Traumatic lumbar punctures occur in up to 30% of lumbar punctures. An observational, multicenter cohort study by Jeffrey Perry et. al. attempted to answer this question and enrolled sequential patients with acute…
A 3 week old male, born NSVD 40w6d, presents to the ED with 2 days of feeding intolerance. Initial vitals show a heart rate of 260, bp 83/51, RR 40, sat 100% RA, temp 37C. You quickly get an EKG pictured below that shows a regular, narrow c…
Source: See citation below Pearl: When applying the Ottawa Ankle Rule, we specifically palpate the posterior maleoli. Explanation: When reviewing the Ottawa Ankle Rule today during morning report the question came up: why do we specificall…
Note: Some of the junior residents are unaware of what the 52 in 52 Review is. In brief. The ALIEM blog picked a list of 52 influential papers in EM (we are on version 2 now) to provide a weekly reading topic. The full list is available her…
By Jer5150 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19669589 Pearl: In cardiac arrest, consider esmolol (500mcg/kg loading dose, then 0-100mcg/kg/min drip) for refractory ventricular fibrillation. Back…
My Hospital computer would not permit an image pertinent to this post to be downloaded without admin privileges, so here is a photo of Quinoa. Pearl: Lidoderm 4% patches are available over the counter. Lidoderm 5% patches are prescription o…
(1) Pearl: If forced to ration, the evidence may support targeting tetanus boosters among our ED wounded to patients in the following categories: A) Any wound and over 50 or never immunized B) Grossly soiled/crushed wound and >5 years si…
Note: Last week’s article, as selected by 52 in 52, was the NEXUS study methodology. I erroneously assumed that the other NEXUS article would be the results, but it was not. I don’t want to leave everyone with a cliffhanger, so…
Risus Sardonicus. (1) Welcome to Tetanus Week! Tetanus is something we deal with every day but to which we give little educational thought. That changes this week. Up first: Are you giving the right medication? Pearl: Patients who were inco…
By James Heilman, MD – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=56596333 Pearl: TXA can be used for post-partum hemorrhage. Its utility for other forms of gynecologic bleeding is unclear. Background: TXA…
Intraluminal Catheter Encrustation. Photo Credit: Royal Society of Chemistry. http://pubs.rsc.org/-/content/articlehtml/2017/tb/c7tb01302g. Pearl: There is likely little advantage gained from treating asymptomatic bacteriuria in patients wi…