During a busy day in the ED, it becomes apparent that the pulling and yanking on your patient’s shoulder has done absolutely nothing to reduce their shoulder. You perform your pre-procedure PSA Checklist, know that this young and acti…
You’re working in RESUS, and you get a notification for hypotension. He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. Yo…
Bottom line up front: (1) Intubating those with TBI or spontaneous ICH is dangerous. You want to prevent increased ICP that is caused by laryngoscopy. (2) Pre-treat with fentanyl if time and the pt’s BP allow. The dose of fentanyl is larger…
Question – How safe is mechanical CPR compared to manual CPR? There are two devices used for mechanical CPR – the AutoPulse and LUCAS – neither of which has been demonstrated to show a survival benefit over manual CPR in r…
Question – How can you use ultrasound to figure out the etiology of a cardiac arrest? Much of the buzz surrounding ultrasound in cardiac arrest revolves around the intra-arrest echo and TEE. You can also use ultrasound to get some inf…
Case – 70 year old male mhx of HTN, IDDM presents with 2 hours of exertional chest pain. His ECG in triage is unremarkable for any ischemic changes. He appears uncomfortable and over the next 30 minutes requires escalating doses of ni…
Clinical Question – What’s a systematic approach you can use to improve your Echo? Case – 66 M with IDDM, HTN, and obesity presents to Resus in septic shock. He is intubated for hypoxemic respiratory failure, and remains p…
A study done by some of our favorite residents and attendings says there is a debate! They surveyed physician sonographers at 6 conferences in 3 academic medical centers in NY. Each person was given 20 seconds per slide to determine whethe…
We all love FOAM, and we all love airway. Today’s pearl will introduce you to a corner of FOAM you may not have come across, as well as a corner of airway management you might not know about. I’m a big fan of Jed Wolpaw’s…
There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. Th…
Title: “The 52 in 52 Review: Early goal-directed therapy in the treatment of severe sepsis and septic shock” Article Citation: Rivers E, Nguyen B, Havstad S, Ressler J, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-dire…
Happy 4th of July! I’m taking the day to review a commonly incurred injury on the holiday: burns. Whether it’s from operating a grill after a few too many libations or an unfortunate encounter with fireworks, the incidence of bu…
Title: “The 52 in 52 Review: Heparin plus TPA compared to Heparin alone for Submassive PE” Article Citation: Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial Inves…
On your busy resus shift you receive a EMS notification that a post arrest patient is en route, ETA 2 minutes. On arrival the patient is being actively bagged by EMS through an endotracheal tube placed in the field. He is hypotensive to 83/…
On your busy overnight trauma shift at Elmhurst, you are the provider during a precipitous vaginal delivery in the trauma bay at 2am. The infant is delivered without complication, and your Pediatric colleagues give you APGAR’s of 8 an…