Resus SinaiEM Blog – Page 12

Do antivirals or steroids help make shingles better?

Posted on January 7, 2019 by Hayley Neher

A patient comes to the emergency department reporting a few days of excruciating pain in a band around his right chest. Today, he developed vesicles over the same area which prompted him to come in. Classic shingles. Like most patients diagnosed with this disease, he is sent home with wound care, return precautions, contact precautions, […]

Double Sequence No-no???

Posted on January 4, 2019 by Hayley Neher

You are the leader of the code team. Your patient is in refractory VF after multiple rounds of shocks and drugs. You’ve tried repositioning the pads into an anterior-posterior position. Looking around, you ask for suggestions. Someone suggests double sequence defibrillation. After all, what’s the harm? Sorry to take away one of your […]

Sedation Drugs

Posted on January 3, 2019 by Hayley Neher

It’s 1 am and things are winding down. The trickle of patients has slowed and it actually looks like you and your team are catching up. Suddenly, you hear yelling, swearing and crashes coming from triage. Other patients are looking around to see what is going on. The sound of the triage nurse comes […]

Nose spray and hemodynamics

Posted on January 2, 2019 by Hayley Neher

Ah, cold and flu season. It’s that joyous time of year when our department is flooded with miserable people complaining of sinus headaches, rhinorrhea and feeling terrible. We all know that for most viruses, symptomatic care is the way to go. A nose spray would be helpful, but what about all of those warning labels […]

Penicillin Allergy and Superbugs

Posted on December 31, 2018 by Hayley Neher

Penicillin allergy is a common finding in many patient charts. Sometimes it can be difficult to figure out who, when and why this label was added to a medical record. Sometimes patients themselves perpetuate the label, unwittingly reporting something a parent told them about a possible reaction as a child, or mistaking side effects […]

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Probiotics. Use them. Love them.

Posted on December 28, 2018 by Hayley Neher

We all prescribe antibiotics frequently. While the debate about who is contributing more to the terrifying antibiotic resistance patterns and the emergence of superbugs rages on, we can sometimes forget or minimize the fact that antibiotics have immediate side effects for our patients. Serious and seriously unpleasant side effects. A publication in JAMA from […]

Doc, I have this burning sensation…

Posted on December 27, 2018 by Hayley Neher

For many of our patients, frequent UTIs can be a big source of discomfort and frequent ED or PMD visits. Women, in particular, are impacted by this issue as they have >50% lifetime risk of acute cystitis. Many are treated with antibiotics which may or may not be appropriate (don’t worry, that is a […]

Santa is Real. Here’s Proof.

Posted on December 25, 2018 by Hayley Neher

Just kidding. Happy Holidays, kids. Follow Santa on his magical trek around the world: https://santatracker.google.com/village.html Bonus: Want to know more about the Dreidel? https://www.chabad.org/holidays/chanukah/article_cdo/aid/597253/jewish/How-to-Play-Dreidel-Sevivon.htm

Lidocaine drip, but not what you think

Posted on December 24, 2018 by Hayley Neher

The practice of using EMLA or LET cream on a wound that is about to be cleansed, explored and sutured is common, especially in the PEDs world. However, both of these options take time to work, which can be a significant barrier to use during a busy shift. A paper published in October 2018 (see […]

Concussion Recovery in Children

Posted on December 21, 2018 by Hayley Neher

An otherwise healthy 11 year old boy is brought to the ED by his parent after “hitting his head pretty hard” during hockey practice. The child was “out of it” for a little while but did not lose consciousness. He seems foggy, complains of a headache and asks to turn off the lights. You diagnose […]

Doc, what if my head explodes?

Posted on December 20, 2018 by Hayley Neher

It’s a busy Monday afternoon. Patients are packed into the department like sardines. You have bruises on your shins from trying to wade through the stretchers to discharge a few people, but now you’re back at the computer ready to pick up some new ones. You click on the next person waiting to be seen, […]

Zombie foot in need of repair

Posted on December 18, 2018 by Hayley Neher

Imagine your patient is minding his or her own business when their foot gets crushed by a bus. This totally hypothetical occurrence is only one of an infinite number of examples of situations that could result in a complex wound(s) needing repair. For wounds on the soles of the feet, adequate anesthesia via local infiltration […]

Line ’em up like a boss

Posted on December 17, 2018 by Hayley Neher

Patients in need of need central lines can often have less than ideal IVC diameters, either because of their disease process or because of their baseline anatomy. Optimizing your chances of success through positioning can make a real difference for both you and your patients. Ideally, placing your patient in Trendelenberg position or asking […]

Does roc rock and suc suck?

Posted on December 14, 2018 by Tina Mathew

A study just published this month in Annals of Emergency Medicine compared the 2 most common paralytics we use in the ED for RSI, rocuronium and succinylcholine. The primary outcome studied was first pass success rate, and the secondary outcome was adverse effects including cardiac arrest, hypotension, dental trauma, and dysrhythmias. While succinylcholine used to be […]

Opioid Conversions

Posted on December 13, 2018 by Tina Mathew

Shoutout to RTO for this tidbit he learned from palliative care on a quicker way to do opioid conversions. Thought I’d share it with you all! Have you had patients who are on opiates at home, need pain relief, not exactly sure how much they may take at home or where to start? Just confused […]