Pressors

The use of vasopressors and inotropes to treat hypotension is common in the emergency department.  It is now standard to start off with norepinephrine as your 1st line agent to treat shock in the ED.  But is norepi always that best choice?…

Non-invasive Ventilation Basics

You have received a notification, EMS has a patient with “APE” or acute pulmonary edema.  The patient arrives in respiratory distress and if you do nothing, she will require intubation.  However, you are well practiced in the us…

Abscess Innovations

Todays pearl was inspired by the amazing and innovative Dr. Vella and Dr. McVane.   We all have had the joy of draining a large pilonidal abscess.  You know the second that abscess opens white pus will flow freely creating mountains of…

Ventilator alarms

You are working resus at 3 am when you hear an alarming vent.  It’s the patient in room “E” who is intubated and has been admitted for 36 hours waiting for a stepdown bed.  The patient is satting 99% and you are tempted to just hit the sile…

Therapeutic Hypercapnia

Ventilator management can be very simple or complex. As boarding continues to plague the emergency department, ventilated patients become more commonplace. The emergency physician should be well versed in ventilator settings as well as acti…

Sepsis 2.0 vs 3.0

A 65 yo M is bibems tachycardic and hypotensive with one week of worsening cough and sob.  Large LLL infiltrate is present on XRay.  You begin treating your patient for severe sepsis and begin to wonder what has been happening in the world…

Unstable Cervical Fractures

Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.   Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures   Jefferson Fracture A burst fracture of the…

150

This pearl was created in light of our impending in-service exam this Wednesday.  Hopefully reading this will give you at least 1 point on the exam. A 19 yo F ingested 150 pills of Tylenol four hours ago and is presenting now because she do…

January 2022
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