Concussion Recovery in Children

Posted on 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 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 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 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 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 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 […]

Acute Flaccid Myelitis
Posted on by Tina Mathew

We’ve gotten an email or two telling us to look out for Acute Flaccid Myelitis (AFM). What is it? Why does it matter? AFM causes flaccid weakness to one or more limbs rapidly in a polio-like neurologic fashion. There can also be cranial nerve involvement, including ophthalmoplegia and dysarthria. There were 80 cases in the […]

To bicarb or not to bicarb
Posted on by Tina Mathew

When, if ever, should we be giving bicarbonate in patients with metabolic acidosis? A study published in The Lancet in July 2018 involved a multicentre RCT in 26 ICUs with 400 patients, called the BICAR-ICU trial. It found that in severe acidemia (<7.2), sodium bicarbonate infusion compared with no infusion did not decrease mortality over […]

PTSD in EM Residents
Posted on by Tina Mathew

Winter is here. It’s colder. Sometimes we don’t see the sun for days. Let’s take a moment to think about some mental health issues. Published in Annals of Emergency Medicine in December 2017 was a piece by some of our very own (Lara Vanyo, Randy Sorge, Angela Chen, and Daniel Lakoff) on posttraumatic stress disorder (PTSD) in […]

Foot vs Bus
Posted on by Tina Mathew

In a totally hypothetical situation, imagine a resident’s foot got run over by a bus and looked like this after arriving in your ED… What sort of things should you be concerned about in injuries like this of extremities? 1. Vascular: Has a vessel been compromised, especially an artery? It is important to control hemorrhage. […]

The Golden S Sign
Posted on by Tina Mathew

Shoutout to the awesome David Cisweski for following up this tidbit from conference and giving us this pearl. Remember in conference when Dr. Jacobi was going over chest X-rays, was talking about the Golden S sign, and we could neither see the S nor the gold? What? – The Golden S sign is also referred to by the more […]

SVT and Paranasal Etripamil
Posted on by Tina Mathew

Have you had one of those resus shifts where everyone and their mother seems to be in an arrhythmia? Have some of them been older patients with SVT that just make you a little antsy about giving medications like adenosine multiple times after Valsalva maneuvers haven’t worked or then having to try an IV beta […]

Air Pollution and Stroke?
Posted on by Tina Mathew

One growing global health issue is ambient air pollution. One of the leading risk factors for disease is fine particulate matter in outdoor air. The WHO states 1 in 8 deaths is due to air pollution. So what is it’s effect on cerebrovascular disease? In Annals of Emergency Medicine from this month, a study was published […]