When consulting your surgical colleagues about a potential small bowel obstruction, you may often be requested to place a nasogastric tube for bowel decompression regardless of how the patient appears clinically. Your patient will almost ce…
Although not a difficult procedure, the traditional approach to a digital nerve block involves two painful injections to the the digital nerves on either side of a finger, and may yield inconsistent results. An alternative, the flexor tendo…
Sometimes the right tool for the job is right in front of your nose. Turns out that 3 nasal inhalations of an isopropol alcohol packets (you know, those swabs you us to prep for a peripheral IV) yields a significant decrease in patient naus…
Of the three primary locations for central line placements, most EM residents seem to be least well-versed in the now rarely placed subclavian central line. The feared complication of pneumothorax steers many doctors to other locales. But t…
What is EMTALA? EMTALA stands for “Emergency Medical Treatment & Labor Act.” It is a federal law enacted by Congress in 1986 to prevent hospitals from sending away patients based on insurance status, race, gender, national origin, preex…
Many clinicians hold that good pain relief with NSAIDs of patients with flank pain should further your suspicion of nephrolithiasis as the etiology. This effect is reportedly due to a decrease in ureterospasm and decreased in GFR leading t…
Tanking up the volume-depleted hypotensive patient requires a fine balance between under-resuscitation and the pulmonary edema of overdoing it. “Dynamic” measures of fluid responsiveness are technically complex and likely inaccessible to mo…
Can’t get that posterior hip location back into place? Don’t have enough collective muscle in the ED to just brute force the thing to where it belongs? Then leverage the power of simple mechanical advantage and utilize the Captain Morgan te…
Many ER residents have found themselves justifying an admission of an acute or decompensated heart failure patient to a skeptical admitting resident. For better or worse, the skepticism is not without reason; an initial ED admission…
So how do you use that big fancy LUCAS machine? Pretty easy actually, but worth knowing before your arresting patient arrives. 1) Position the machine on the patient: Put the yellow back plate under the patient; this should be neatly center…
Want to read an EKG like a 3rd year med student? Recognize ST elevations. Want to blow your attending away with your savant-like EKG mastery? Start learning all the myriad STEMI equivalents. For today: the de Winter’s T-wave. What is…
Looking to up your lac repair game? With a simple modification, the old dependable horizontal mattress stitch can be transformed into the notably improved and versatile modified locking horizontal mattress stitch. This stitch provide…
The use of vasopressors and inotropes to treat hypotension is common in the emergency department. It is now standard to start off with norepinephrine as your 1st line agent to treat shock in the ED. But is norepi always that best choice?…
You have received a notification, EMS has a patient with “APE” or acute pulmonary edema. The patient arrives in respiratory distress and if you do nothing, she will require intubation. However, you are well practiced in the us…
Todays pearl was inspired by the amazing and innovative Dr. Vella and Dr. McVane. We all have had the joy of draining a large pilonidal abscess. You know the second that abscess opens white pus will flow freely creating mountains of…
