Alright, you did it. LP complete! You look at those crystal clear tubes, and say to yourself…. “Ohhh yeah, champagne tap!” But then…you realize you ordered 9000 tests on these few drops of precious fluid and have no idea how to correc…
A 45 year old male comes into the ED with a sudden, severe headache. It started while he was at work yesterday and was the worst of his life. It started feeling a little better, but hasn’t totally gone away and his wife made him come to get…
A CT abd/pelvis without contrast is one of our go-to studies when evaluating for nephrolithiasis in a patient with acute flank pain. And it’s a really good one too–a recent meta-analysis of CT for suspected renal stone showed a sensit…
Tl;dr: (1) Expected false positive rate for any one statistical test is generally 0.05 (aka, alpha). But this error compounds when you run multiple statistical tests. (2) Adjust your target p-value by applying the Bonferonni correction (0.0…
Tl;dr: (1) Don’t forget to order a uric acid with the labs as it increases the specificity in diagnosing preeclampsia. (2) If the pt is preeclamptic with severe features (see below), then give 4g IV Mg followed by 1-2gr/hr infusion for 24hr…
Tl;dr: Failed OGT placement in an intubated patient is common. Try using an 8.0 ETT as an introducer into the esophagus to prevent coiling in the mouth / upper esophagus. Placement of an OGT or NGT can often be challenging in an intu…
Tl;dr: (1) Never rock the pelvis. Firmly squeeze and hold. (2) Consider quickly assessing for rectal or vaginal bleeding prior to binder application as this would suggest an open fx into the vag / rectal vault. It will be difficult to compl…
Do you ever have a patient with a rash you just don’t recognize? If you’re like me, it happens all the time and it can be hard to organize your differential. Michelle Lin (https://aliemcards.com/cards/rash-unknown) published a…
Do you know David Cisewski? He’s incredible and he’s written an incredible review on buprenorphine (http://www.emdocs.net/buprenorphine-where-do-we-stand/) that I’d like to tell you all about. Buprenorphine marketed as Su…
Ultrasound for kidney stone has always been confusing. If we do the ultrasound and find no hydro, don’t we need the CT to rule an alternate diagnosis? If we do the ultrasound and find hydro, don’t we need a CT to see if the st…
ESRD patients are typically “hard sticks.” The arm with the fistula is typically off limits (unless in emergency settings) and the other arm is either difficult to access or occasionally has an old fistula. This issue came up…
Traditionally, central line placement in the subclavian vein (SCV) involves a landmark-based approach in which the needle is guided under the clavicle. For the U/S lovers, there is an alternative approach to the subclavian in which the sono…
Bottom line up front: A recent large, high quality meta-analysis reported a significant mortality effect with the use of liberal, rather than conservative, oxygen supplementation. The number needed harm for 30-day mortality was 1 in 126. A…
Bottom line up front: (1) Intubating those with TBI or spontaneous ICH is dangerous. You want to prevent increased ICP that is caused by laryngoscopy. (2) Pre-treat with fentanyl if time and the pt’s BP allow. The dose of fentanyl is larger…
Knee dislocations are a dangerous and easily missed diagnosis. Morbidity is high as 20% have a serious vascular injury, many of which lead to amputation. This can occur with even ground levels falls in elderly and obese patients, so a hig…
