LET – not just for lacs

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…

Pigtail Catheters for Pneumothorax

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…

When to give activated charcoal

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…

Plasmalyte in hyperkalemia

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…

Painless Foley insertion

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…

DAWN of a new era in stroke care

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…

C1 Esterase Inhibitor Deficiency

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…

December 2022
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