There are almost 1,000,000 pulmonary embolisms per year. Do all of them need to be admitted? From a dispo standpoint, it can be easier when you’re at larger academic centers to admit or obs them all but the reality is that s…
You’re working in the Cardiac Room as a new PGY-2 and the triage nurse calls you to evaluate a patient. He’s about 40 years old, slightly overweight, known to the ED for chronic alcohol abuse, and appears to be intoxicated yet again.The nur…
Of course your asthma patients with acute bronchitis will get some steroids….but what about your non-asthmatic patients? Evidence shows that most patients with acute bronchitis do not need steroids. What’s the evidence? Study:…
Is one dose of PO dexamethasone enough or do you need to send your adult asthmatic patient home on a 5 day oral prednisone course? A noninferiority study published in Annals of Emergency Medicine in 2016 says maybe it doesn’t matter….
Title: “The 52 in 52 Review: Heparin plus TPA compared to Heparin alone for Submassive PE” Article Citation: Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial Inves…
You are called to triage to assess a man for shortness of breath. Per EMS, this is a 46 year old male with a history of substance abuse and HTN, found by his wife this afternoon, overdosed on Heroin and barely breathing. EMS arrived on scen…
On your busy resus shift you receive a EMS notification that a post arrest patient is en route, ETA 2 minutes. On arrival the patient is being actively bagged by EMS through an endotracheal tube placed in the field. He is hypotensive to 83/…
Inspired by a morning report discussion from our very own Lara Vanyo on preoxygenation strategies, I thought it would helpful for a brief run-down on the button-pushing needed to perform preoxygenation by way of noninvasive ventilation. The…
“I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.” – Rocky Graziano Article Citation: Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predi…
“There is nothing like the cure of fresh air for cases of bladder infection, paranoia, and Cartesian thinking.” -Rawi Hage Title: “The 52 in 52 Review: Noninvasive ventilation in acute cardiogenic pulmonary edema” Article Cita…
Yesterday, we learned about acute mountain sickness (AMS) and high altitude cerebral edema (HACE). Today we will tackle high altitude pulmonary edema (HAPE), the deadliest of the altitude illnesses. HAPE generally occurs above 3000m, but in…
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…
Chest tubes hurt…I imagine. And the few times I’ve done them (x2) I’ve wondered couldn’t that person have just gotten a pigtail?! What does the literature say? Voisin et al 2014 asked if large pneumothoraces (>2-3…
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…
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…
