The intraosseous line. What a beautiful solution to so many problems. Let’s take a minute to reflect on the IO, what it can do, how to do it, and to assuage your fears of complications. When to use an IO: If you think, “should we put in an…
You are in RESUS feeling like a boss (either it’s your last RESUS shift because you’re becoming a senior, you have finally made i through 2nd year and have learned how to tell Gueldye “no”, or are finally reaching the end of end…
You’re working overnight when your 10th patient comes in complaining of chronic back pain. You order acetaminophen and an NSAID but the patient refuses to take them. They’re upset, agitated and demanding their usual percocet as…
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: 24yo male p/w abdominal pain, nausea and vomiting. This is his 4th ED visit in the past two months. He has had multiple workups including labs, abdominal ultrasound and CT, all of which were normal. He even followed up with a gastroen…
Case – 26M with no medical history presents with chest pain and palpitations. He states that he passed out while walking. He denies associated symptoms or family history of sudden cardiac death. ECG: Question – What are the ECG…
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…
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…
