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 […]

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 […]

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 […]

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 […]

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 […]