There was a study published on the Journal of Critical Care Medicine in July 2011 comparing US guided vs landmark approach to subclavian vein central line placement. In the study, “subclavian vein cannulation was achieved in 100% of…
In a patient w/ a trach who is now hypoxic and/or the trach is malfunctioning a bougie may potentially be passed through the trach directed cephalad, once the provider who is at the head and performing direct laryngoscopy is able to visuali…
After intubation, a quick and easy way to estimate ET tube position is by palpating the sternal notch and feeling for the ET cuff. By holding on to the pilot balloon (balloon used to check if cuff is inflated) and palpating on the sternal…
53 yo M w/ PMHx of HTN, CAD, and CHF s/p LVAD placement presents to the ED w/ c/o CP. Patient reports he had mild CP overnight but this morning woke up with increasing SOB and severe CP radiating to his R arm. He immediately called 911 an…
EMS calls in to the department and states they are en-route w/ an ETA of 5 minutes w/ an 8 yo M w/ no known PMHx in severe distress, no further history provided. 3 minutes later an 8 yo M is wheeled into the department by EMS, the child is…
23 yo M w/ no known PMHx presents to the ED BIBEMS for AMS. Patient is awake but appears slightly confused, he is salivating and spitting in the ED but able to protect his airway and his vitals are stable, he has no signs of trauma, no abn…
Elderly female w/ PMHx of TIA, DM, and remote breast Cancer history reportedly in remission presented to the ED w/ c/o R-sided neck pain radiating to her R trapezius for 2 days. No fevers or chills, no Hx of trauma or falls, no vision chan…
For Patients in Cardiac Arrest use LMA until there is ROSC and situation under control Induction Agents Etomidate: 0.3mg/kg IV dose, “cardiac Stable,” unclear effect if dose decreased, may not be ideal for patients…
17-month-old F w/ no sig PMHx presents to the ED accompanied by her mother who is concerned because her baby is “acting drunk.” Mother reports child was staying with grandparents over the weekend and today began “walking f…
Interesting Case of Facial Swelling. 55 yo F w/ PMHx of HTN, DM, and ESRD on HD presented to the ED w/ c/o facial redness and swelling progressively worsening for 3 days. Patient discharged 7 days prior from outside hospital but una…
Most toxic mushroom ingestions simply result in abdominal cramping, nausea/vomiting and diarrhea. But beware of amatoxin-containing mushrooms appropriately termed the “deadly white Amanitas” (i.e. A. phalloides (figure 1), A. bisporigera (…
Here are the highlights from the 2012 ACEP Clinical Policy regarding Critical Issues in the Initial Evaluation and Management of Patients Presenting to the ED in Early Pregnancy: The initial quantitative BhCG level does not help to distingu…
This may be surprising to many of you, but some of our patients abuse medication. In addition to Dilaudid, morphine, and Percocet, lets add topical ophthalmic anesthetics such as tetracaine to our “red flag” list. The most common offender…
Extracranial internal carotid artery dissection can cause ischemic stroke by thrombus formation or thromboembolism and subsequent arterial occlusion. In fact, it is the 2nd most common etiology of strokes in patients younger than 45 years….
We’ve all heard that lidocaine buffered with sodium bicarbonate makes the local anesthetic closer to physiologic pH. This in turn decreases time of onset and infiltration pain. However, upon further investigation, this may not be so true….
