A middle-aged man presented to the ED with chest pain for the past 2 hours. This is his EKG. What’s your next move?       If you look at the anterior leads, you’ll notice upsloping ST depressions and tall, symmetric, prominent t waves. This pattern is known as De Winter’s T wave pattern. […]

The traditional dosing range of ketamine for analgesia is 0.1-0.6mg/kg IV.  It’s funny to use the word traditional because ketamine is still not completely universally considered an option for analgesia, despite its increasingly wider acceptance in the ED and growing amount of research literature supporting its use as an analgesic agent. It’s still technically off-label […]

  Chief Complaint: Pregnant, vaginal bleeding An evaluation of first trimester vaginal bleeding certainly entails a pelvic exam and a bedside ultrasound to eval for ectoptic pregnancy. We are looking for an intrauterine pregnancy. You know the feeling. Please, just let me visualize an IUP! If you still haven’t tried using the linear probe to […]

  Take a look at the above EKG. If you saw this in a 70 year old patient with chest pain, you might be a bit concerned. Tachycardic, inverted T waves anteriorly, a partial RBBB in V1. Are these ischemic changes going on? Where is this man’s prior EKG?! But wait, here’s the good news. […]

This week we have seen some interesting uses of naloxone in the Sinai ED, so let’s review: Naloxone for pruritis? Why yes. Several randomized controlled trials have shown Naloxone to be efficacious in all sorts of pruritic conditions – chronic urticarial, atopic dermatitis, Psoriasis Vulgaris – to name a few. The dose range is high, […]