Last week, we closed out the week by discussing the dischargable, ‘benign sugars,’ but what about when you have the legit ‘sugars.’ We’re talking about DKA. While the algorithm for DKA is fairly straight forward – fluids, insulin, replete l…
Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis: Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion Contraindication…
Before answering that question, I need to acknowledge EM topics (http://www.emtopics.com/article-a-day/2016/discharge-glucose-level-is-not-associated-with-return-to-ed) for bringing this important article to my attention since this is nearl…
We are all too familiar with tachypnic and the occasional bradypnic patient (i.e. narcan deficient) rolling through resus, but rarely do we come across platypnic and orthodeoxic (except for yesterday). In order to come across them, you need…
If yesterday’s post on Roids didn’t get you jack’d then maybe today’s will! Here’s part deuce – Topical Steroids Spoiler alert – if you are using 1% hydrocortisone for every rash everywhere then you…
Summer’s here! Time to hit the gym and review your steroid-knowledge. What’s the difference between prednisone/prednisolone/methyprednisolone again? Well, I’ll give you a hint… its not a pre/post work out fix! [spac…
Lumbar punctures (LPs) can be tricky even for an experienced provider. Here are some pro tips to help you look like an all-star! Set up: The LP tray contains only a small amount of lidocaine (~3mls). If you need to make a second attempt in…
Did you know you can use a regular old metal detector to rule-in a metallic swallowed foreign body in children? It’s true! Several studies have been published in The Journal of Accident and Emergency Medicine out of The Royal Hospita…
Serial Troponin for Atypical Symptoms? – PART III [spacer height=”20px”] In general, the literature suggests that elderly patients who present with atypical chest pain should receive at least two troponins for several reas…
This is part two of a three-part series to answer the question, “it is acceptable to order a single troponin in an elderly patient with dizziness, weakness, or a similarly vague anginal equivalent?” So far, we understand that tr…
You’re working in Geri and have 10 elderly patients with dizziness and/or SOB on your board. None of them can reliably recall when their symptoms started. You are about to order “just one trop” on all of them. After all, e…
Given the evolving definition of sepsis and the continual push to report sepsis measures to State Health Departments and CMS, I thought the time is ripe to revisit a popular topic: the significance of elevated lactate in the ED. After all,…
If you’re like me, you probably hook your chest tube up to a Pleur-Evac, put it on the ground, then back away slowly. Who knows what goes on in that mysterious bubbling white box? Hopefully this will post shed some light. [spacer heig…
If you’ve ever been confused about why cooling matters in post-cardiac arrest, when to do it, how to order it, or what temperature (34C? 36C?) is best, read on. [spacer height=”20px”] Why do we do this? To protect the brai…
When Should I Use It? For cases of profound beta blocker overdose with clinically significant cardiovascular depression (symptomatic bradycardia, hemodynamic instability). [spacer height=”20px”] Since many patients are on both b…
