In recent years, a number of states have decriminalized marijuana for medical use, and some have even decriminalized recreational use. This trend is likely to continue. Much of this marijuana – particularly when used recreationally – is con…
Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-206. What we already know about the topic: Patients generally have poor survival an…
Welcome to Digoxin Day, Part 2! Like all sequels, this is sure to be even better than the original. Cardiac Physiology of Digoxin: Cardiac glycosides increase parasympathetic tone by acting on the vagus nerve. They also depress myoca…
Digoxin is a cardiac glycoside, and it has a narrow therapeutic window (0.5-2 ng/ml). Due to its sub-milligram dosing, its dependence on renal clearance, and its interactions with many other drugs, digoxin toxicity is a real concern for pat…
When a patient presents with orbital compartment syndrome, performing a lateral canthotomy and cantholysis can be vision-saving. You may only have 60-100 minutes until the patient experiences permanent visual sequelae. Are you ready? …
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7. What we already know about the…
When you examine the ECG of a patient who syncopized, what are you looking for? You’re probably checking for a prolonged QT interval, signs of left ventricular hypertrophy consistent with hypertrophic obstructive cardiomyopathy, a delta wav…
To call opioid use in the US a “problem” is a gross understatement, and most of us in Emergency Medicine appreciate this. You may believe that if you only prescribe a small number of pills to an opioid-naïve patient who is truly in pain, yo…
*Thanks to Dr. Clark Owyang for following this “case” with me! On February 13, Kim Jong-un, son of Kim Jong-il and half-brother of current North Korean leader Kim Jong-un, was poisoned at Kuala Lumpur airport in Malaysia….
De Gans J, Van de Beek, D. Dexamethasone in adults with bacterial meningitis. New Engl J Med. 2002;347(20):1549-56. What we already know about the topic: Bacterial meningitis is a dangerous condition with significant associated morbi…
Methylene blue (MB) is a heterocyclic aromatic compound, and a basic thiazine dye. We all know that it is used to treat methemoglobinemia. MB is an oxidizing agent, which becomes a reducing agent when NADPH reduces it to leukomethylene blue…
Myxedema coma, or severe hypothyroidism, is an emergent condition with a high mortality rate (30-60%). Our patients rely on us to catch it early and treat aggressively. About 90% of cases occur during the winter months, and it is rarely see…
In October 2016, the Pulmonary Embolism in Syncope Italian Trial (PESIT) was published in the New England Journal of Medicine. Since its publication, it has generated a great deal of conversation and controversy. First, a brief rundo…
Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67. What we already know about the topic: Carbon monoxide poisoning is responsible for about 40,000 v…
When we call our colleagues from ENT with a question about a patient’s tracheostomy, they’ll want to know what type of tube the patient has. Let’s go over two types: Plastic Tubes Flexible plastic tubes (most common brand name is Shi…
