A middle-aged man presented to the ED with chest pain for the past 2 hours. This is his EKG. What’s your next move? If you look at the anterior leads, you’ll notice upsloping ST depressions and tall,…
The traditional dosing range of ketamine for analgesia is 0.1-0.6mg/kg IV. It’s funny to use the word traditional because ketamine is still not completely universally considered an option for analgesia, despite its increasingly wider…
Chief Complaint: Pregnant, vaginal bleeding An evaluation of first trimester vaginal bleeding certainly entails a pelvic exam and a bedside ultrasound to eval for ectoptic pregnancy. We are looking for an intrauterine pregnancy. You…
How do you calculate the correct ETT size for a child in a pediatric resuscitation? ETT size = (age + 16) / 4 ETT size = (age/4) + 4 ETT size = 4 + 1/4 age If you find yourself thinking about the order of operations (PEMDAS for anyone who m…
It’s not just about the squeeze. You gotta think about the filling. Yes, today we’re talking about diastology (I didn’t make that word up) AKA diastolic heart failure AKA heart failure with preserved ejection fraction AKA…
Take a look at the above EKG. If you saw this in a 70 year old patient with chest pain, you might be a bit concerned. Tachycardic, inverted T waves anteriorly, a partial RBBB in V1. Are these ischemic changes going on? Where is this…
Steri-strip and Suture Combo Technique for Repairing Fragile Skin Old people. They come with all sorts of problems and complications. Even simple lacerations are more complicated with them. Have you ever encountered a laceration in…
All the hard parts are done in the placement of your central line. You nicked the vein and NOT the artery. The wire threaded smoothly. You got confirmation on your ultrasound. Now, you just insert the triple lumen in over the wire. Insertin…
This week we have seen some interesting uses of naloxone in the Sinai ED, so let’s review: Naloxone for pruritis? Why yes. Several randomized controlled trials have shown Naloxone to be efficacious in all sorts of pruritic conditions – chro…
Verbal de-escalation is a powerful and effective skill to help calm agitated and aggressive patients. This method is proven safe, effective and decreases the likelihood for restraints. Among properly trained physicians this process takes le…
“Want to hear the funniest therapy that actually works?” – Dr. Ben Schnapp, former Chief Resident extraordinaire [spacer height=”20px”] It was my first month of intern year, and I had just presented a patient w…
Garfield had it right. Mondays are the worst. [spacer height=”20px”] Want proof? Well, in 2004 the CDC published a survey measuring health care utilization among US Emergency Departments over a 10 year period. The results? ED v…
We are all familiar with the RUSH exam (see Dr. Weingart’s original article if you’re not). Since it’s been a recurring theme this week, we are going to focus on the IVC measurement of the spontaneously breathing patient. This will not be a…
Name that fracture, ideal imaging modality, and treatment including indication for operative repair: That would be a classic scaphoid fracture. It should ideally be imaged first with a three-view x-ray (AP, lateral, and scaphoid view – 30 d…
As we discussed yesterday, the treatment algorithm for DKA is fairly straightforward with a few subtleties we rarely appreciate, until now. Yesterday we focused on fluids, today we move on to the insulin. Can we offer the patient anything e…
