The World Cup is on! Every four years, the beautiful game moves the big stage where we get to see the sport played at its finest. We also get to see the slide tackles, the dives and, more concerning, the head injuries…even if voluntar…
Today we have a guest Pearl writer, our very own rising PGY2 Arjun Prabhu. He learned about an interesting complication while at a committee meeting and wanted to share: You are getting set up for a femoral central line in resus and are thi…
Imagine you’re in resus, juggling your many sepsis patients, when a patient is rushed into the room. All you hear is “trach problem.” Before you jump to the AMAC > ENT pathway, think about this simple outline. There are 3 main trach emer…
As ED physicians, we fear the patient we can’t intubate, can’t ventilate. We’ve had a rash of emergency cricothyrotomies in our ED recently. Though rare, you never know when you might need to perform this life saving procedure. Review the b…
Have you spent the past week wondering how you could express empathy more successfully? Don’t re-invent the wheel, use a tool from palliative care — NURSE statements! Name the emotion: “Many people would feel angry if that happe…
Ornithine transcarbamylase deficiency, citrullinemia, methylmalonic acidemia, tyrosinemia, phenylketonuria, Galactosemia… did I lose you yet? These words bring me back to the dark place of step one studying. So take a deep breath, don’t wor…
Have you ever tried to figure out what the appropriate starting dose of naloxone is? When you dig in the literature it’s pretty clear that its a lot of hand waving and muddy water — but let me give you an approach and some of th…
I have a new niece, Kaitlyn Marie, who is just crushing life so far, but my brother called me and asked all about neonatal jaundice, so here is some info to help you the next time you see this in the peds ED or someone you know calls you to…
We know Jim Tsung can ultrasound anything, but in the peds world we all need to beef up our lung ultrasounds because more and more evidence is piling up to support the use of ultrasound to diagnose pediatric pneumonia. A recent meta-analysi…
Consider inhaled nitric oxide in massive PE and watch for upcoming literature. Massive PE elevates pulmonary vascular resistance leading to right ventricular failure, hypoxemia, and cardiogenic shock. Inhaled nitric oxide selectively dilate…
Ever been annoyed when you try to admit a liver patient and the MAR requests that you perform a diagnostic tap prior to admission? Here is the data behind why we perform diagnostic paracentesis in the ED. Bottom line: performing diagnostic…
Try an interscalene block! It anesthetizes C5-7 and is used in shoulder surgery- surely that is good enough for a measly little reduction. Studies in the ED have shown decreased time in the ED and good anesthesia for shoulder reduction. Her…
Don’t want to read more? Here is the summary: There are a bunch of studies coming out looking at risk stratification for Aortic Dissection (AD). On chest pain patients check for focal sensory/motor neurologic deficit, pulse deficit an…
Ok, so you know there is controversy in the use of steroids in septic shock, but what does the data actually support in terms of when you should and should not use them — here is a guide! Don’t want to read more? Here is the jis…
You’re working in Acute 2 slogging away when you hear “ED TEAM 7000” overhead. You sprint faster than everyone else and get there first. Congrats! You made it through the maze of Sinai. When you get there, you find a woman…
