LET gel, a combination of 4% lidocaine, 0.1% (1:1000) epinephrine, and 0.5% tetracaine in a methylcellulose gel, is commonly used as a topical anesthetic for the repair of skin lacerations, especially in children. It often eliminates the ne…
A patient presents 3 days after a lung biopsy with shortness of breath and chest pain. He has a normal HR and BP but SpO2 is 92% on non-rebreather at 15lpm. On bedside ultrasound, he has absent lung sliding on the right, and CXR confirms a…
A patient presents 30 minutes after intentional ingestion of 25 tabs of alprazolam. He is awake and talking, with normal vitals. This is a perfect situation in which to give activated charcoal, something that seems to be often discussed but…
Hot off the press is a new study evaluating the effect of door-to-diuretic time on in-hospital mortality in patients presenting with acute heart failure. This study was closely modeled after a prior study by Matsue et al last year (reviewed…
A patient with end-stage renal disease on dialysis presents with hypotension and sepsis. He is also hyperkalemic. How do you fluid resuscitate him? Prior teaching was to never give potassium-containing solutions to a hyperkalemic patient. H…
A 57yo M presents with new onset urinary retention for 3 days. The triage nurse attempts to place a foley catheter but is unable to pass it. Bedside ultrasound confirms a distended bladder. The patient is now complaining of urethral discomf…
Thrombectomy performed within 6 hours of symptom onset has been demonstrated to significantly improve clinical outcomes after stroke. Though there is generally diminishing benefit with increased time interval from last known well to the tim…
The use of an age-adjusted D-dimer cutoff in ruling out venous thromboembolism for patients over the age of 50 is now largely accepted. Most commonly, the age-adjusted dimer cutoff is calculated based on the patient’s age x 10 (e.g. t…
When a patient presents with hyperkalemia, in addition to the initial steps of obtaining an EKG and treating with calcium, insulin, glucose, albuterol, and furosemide if indicated, consultants will often ask us to also administer sodium pol…
A 67 year-old man presents with lower lip swelling for the past two hours, and tells you he was recently diagnosed with acquired C1 esterase inhibitor deficiency. He has normal vitals, is speaking in full sentences, and denies any sensation…
A patient is sent from nursing home at 10pm for a non-functioning PEG tube. He has a prior history of stroke with L sided weakness and is now bedbound at baseline. He has stable vitals, no abdominal tenderness, and is otherwise well appeari…
Injuries to the hands are a frequent complaint in the emergency department. When the injury isn’t limited to a single digit, or involves larger areas of the hand such as a burn or deep laceration, a nerve block can be an effective opt…
