Today’s pearl is courtesy of the sea and (the other) JP: how to remove a fish hook from human flesh. 1. Remove any fish hook flair – ie weights, lines, weird hair looking things, etc. 2. Clean the surrounding skin with betadine. 3. An…
Today’s pearl is courtesy of North Korea. They claimed that Otto Warmbier, an imprisoned American who unfortunately died a few days after his return to the US, had suffered brain damage after contracting botulism. If you think that sounds w…
Stiell IG, Wells GA, Vandemheen K, Clement C, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001 May 5;357(9266):1391-6. PMID: 11356436 What we already know: Prior to this study, there was disagreement…
If you are unsuccessful with an LP, consider ditching the midline angle and instead approaching laterally. The lateral approach allows you to avoid the supraspinous and interspinous ligaments, which are often crunchy and calcified in older…
I was recently helping the resus resident with establishing peripheral IV access in a hemodynamically stable patient who needed to be urgently loaded with keppra. Multiple attempts by myself and 3 other providers were unsuccessful. I couldn…
Spiro DM, Tay KY, Arnold DH, Dziura JD, et al. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41. PMID: 16968847 What we already know: The most common…
A 1-week-old infant is brought in by his mother for decreased responsiveness and vomiting. Prenatal and birth history were unremarkable. He is cool, clammy, and lethargic. Nurses are unable to obtain a blood pressure, and he is hypoglycemic…
One of the most frequent requests we receive as teaching residents (and probably as senior residents) is assistance with performing paracenteses. By now, all of the EM residents are probably comfortable with this procedure. But, July is com…
Today in resus, the nurse told me that one of the patients, a woman being treated with vancomycin, began to appear flushed and kept itching her face. The patient denied respiratory or GI complaints. She denied previous drug allergies, and h…
Bjornson CL, Klassen TP, Williamson J, Brant R, et al; Pediatric Emergency Research Canada Network. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004 Sep 23;351(13):1306-13. PMID: 15385657 W…
Welcome to the inaugural post of the TR pearl series – Consultant Collaboration! If you’ve been watching or reading the news, you probably saw headlines about the new emerging superbug: multidrug-resistant (MDR) Candida auris. But did…
Your 29 year female patient arrives to Resus with a rapid heart rate of 215. Her blood pressure is 129/72. She appears pretty comfortable, however complains of mild shortness of breath and chest pain. She has no cardiac history and no previ…
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/…
Is there any data behind renal hydration prior to CT to prevent contrast induced nephropathy? Or is it just a habit we picked up along the way and has no clinical benefit? The AMACING trial answers that question. Prophylactic Hydration to P…
Rural Pearl- First time seizure You are back for you solo overnight shift at Rural General Hospital. At 2 am a new patient comes in with his fiance. He is a 25 year old male and the fiance says the patient had a “shaking episodes”…
