Hyperglycemia is frequently seen in the ED. Practice variation is common in terms of glucose reduction for safe discharge. The question is does improving this number benefit our patients?? Study: Driver, B et al. Discharge Glucose…
During ACLS, valuable seconds are often wasted while trying to analyze the rhythm on the tiny monitor. Is it VT? VF? PEA? Then when we decide we do want to deliver the shock, even more time is wasted charging the defibrillator. All this los…
Citation Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. 2009. HINTS to diagnose stroke in the acute vestibular syndrome. Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. S…
Blood-letting was once one of the main medical treatments offered to patients before the advent of modern medicine, but did you know it is still a possible therapy that can be used in the ED today? According to a study by Eiser et al in 199…
Article Citation Marik PE, Flemmer M, Harrison W: The risk of catheter-related bloodstream infection with femoral venous catheter as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and met…
At our wellness conference we talked about different strategies to manage burnout through gratitude, deep breathing exercises and story-telling. Today we will add another technique to our wellness arsenal: spending time in nature. In NYC, t…
A 44M with no PMH slipped and fell on his hand while playing with his kids in the park. He has swelling and pain over thumb MCP joint that is exacerbated by movement. The xray of his thumb is above, what is your diagnosis? This injury is kn…
We do a lot of life-saving procedures and interventions on a daily basis in the emergency room. However, there are some much less frequent but equally as important life-saving procedures we need to know how to do. Today we will review how t…
A mother brings her 4 day old newborn baby boy into the Peds ED for bilateral eye discharge. Mom tells you he was full-term and healthy, but she did not have prenatal care. The baby is well appearing and is eating, urinating and defecating …
Article Citation: CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a random…
Case: 40 year old male presenting with rash for one day. Patient recently started Bactrim, endorsing flu-like symptoms for the past 2 days. Chest and back are erythematous and warm. In the ED, patient is febrile and tachycardic. Based on th…
Article Citation Stiell IG, Greenberg GH, McKnight RD, Nair RC, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3;269(9):1127-32. PMID 8433468 What we already k…
A 36F presenting with wrist pain after a fall on an outstretched hand. She has pain and swelling over the dorsal-radial aspect of her hand. Her xray is below, what is the diagnosis? It’s the spilled tea cup sign, but can you remember which…
Article citation: Backus BE, Six AJ, Kelder JC, Bosschaert MA, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. (Link to the article here)…
In the ED we think a lot about pulmonary embolism, and thus decision rules, d-dimers and CTAs. Because we have a low threshold to test for PE, we spend a fair amount of time trying to not get that CTA. There are a number of tools to risk st…
