You’re halfway through your pediatric overnight shift and you have a 15 yr old come in brought in by his parents. You see him with his head turned all the way to the right and in some amount of pain. You open up his chart and note multiple psych encounters and a med list showing […]

We’ve all been there. The patient in respiratory distress (or any other reason) that you’ve now decided needs an intubation. You’re all set up, you’ve done your checklist, you’ve done your time out, and the meds have gone in. You wait till you think the meds have probably worked and slide the blade into the […]

It’s early medical school teaching that pregnancy puts a patient at increased risk for thrombotic diseases like DVT and PE, but what can you do when you actually find one? Classic teaching and a quick poll of our residency (n=4) has everyone saying “Coumadin-no, heparin-yes.” While accurate and relatively well studied, it leaves out a […]

Using Flomax for ureteral stones has been a controversial topic. A meta-analysis of 8 randomized controlled trials consisted of 1,384 patients showed that there was no benefit in giving Flomax to those with ureteral stones < 5mm. However, Flomax was beneficial for patients with stones > 5mm (risk difference=22%; 95% confidence interval 12% to 33%; […]

Delivering adequate analgesia in pediatric patients in a timely fashion is difficult. IV route requires staffing and produces additional pain and anxiety in this population. However, the oral route has a delayed onset. The benefit to IN fentanyl is that it can provide adequate control pain without IV access. Even if the patient still needs […]

Both etomidate and ketamine are commonly used as the induction agent for RSI in adult trauma patients. There are concerns about etomidate-associated adrenal suppression leading to complications in critically ill patients. This is a retrospective study comparing the outcome of patients intubated in the ED with etomidate vs. ketamine. There were a total of 968 […]

The current treatment for epistaxis consists of holding pressure, local vasoconstrictor, silver nitrate or anterior nasal packing. Recently, the use of topical TXA has been purposed. A previous study in 2013 showed that topical TXA resulted in shorter epistaxis control and shorter ED LOS in patients not on any anticoagulants or antiplatelets. A new randomized […]

Article Citation: Karounis H, Gouin S, Eisman H, Chalut D, et al. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med. 2004 Jul;11(7):730-5. PMID: 15231459 What we already know about the topic: Traumatic lacerations are one of the most common causes […]