Penicillin allergy is a common finding in many patient charts. Sometimes it can be difficult to figure out who, when and why this label was added to a medical record. Sometimes patients themselves perpetuate the label, unwittingly…
We all prescribe antibiotics frequently. While the debate about who is contributing more to the terrifying antibiotic resistance patterns and the emergence of superbugs rages on, we can sometimes forget or minimize the fact that antibiotic…
For many of our patients, frequent UTIs can be a big source of discomfort and frequent ED or PMD visits. Women, in particular, are impacted by this issue as they have >50% lifetime risk of acute cystitis. Many are treated with a…
Just kidding. Happy Holidays, kids. Follow Santa on his magical trek around the world: https://santatracker.google.com/village.html Bonus: Want to know more about the Dreidel? https://www.chabad.org/holidays/chanukah/article_…
The practice of using EMLA or LET cream on a wound that is about to be cleansed, explored and sutured is common, especially in the PEDs world. However, both of these options take time to work, which can be a significant barrier to use duri…
An otherwise healthy 11 year old boy is brought to the ED by his parent after “hitting his head pretty hard” during hockey practice. The child was “out of it” for a little while but did not lose consciousness. He seems foggy, complains of…
It’s a busy Monday afternoon. Patients are packed into the department like sardines. You have bruises on your shins from trying to wade through the stretchers to discharge a few people, but now you’re back at the computer ready to pick up…
Imagine your patient is minding his or her own business when their foot gets crushed by a bus. This totally hypothetical occurrence is only one of an infinite number of examples of situations that could result in a complex wound(s) needing…
Patients in need of need central lines can often have less than ideal IVC diameters, either because of their disease process or because of their baseline anatomy. Optimizing your chances of success through positioning can make a real diffe…
A study just published this month in Annals of Emergency Medicine compared the 2 most common paralytics we use in the ED for RSI, rocuronium and succinylcholine. The primary outcome studied was first pass success rate, and the secondary out…
Shoutout to RTO for this tidbit he learned from palliative care on a quicker way to do opioid conversions. Thought I’d share it with you all! Have you had patients who are on opiates at home, need pain relief, not exactly sure how muc…
We’ve gotten an email or two telling us to look out for Acute Flaccid Myelitis (AFM). What is it? Why does it matter? AFM causes flaccid weakness to one or more limbs rapidly in a polio-like neurologic fashion. There can also be crani…
When, if ever, should we be giving bicarbonate in patients with metabolic acidosis? A study published in The Lancet in July 2018 involved a multicentre RCT in 26 ICUs with 400 patients, called the BICAR-ICU trial. It found that in severe ac…
Winter is here. It’s colder. Sometimes we don’t see the sun for days. Let’s take a moment to think about some mental health issues. Published in Annals of Emergency Medicine in December 2017 was a piece by some of our very…
In a totally hypothetical situation, imagine a resident’s foot got run over by a bus and looked like this after arriving in your ED… What sort of things should you be concerned about in injuries like this of extremities? 1. Vasc…
