Resus SinaiEM Blog – Page 38

The Ten Commandments

Posted on August 25, 2016 by Randy Sorge

Verbal de-escalation is a powerful and effective skill to help calm agitated and aggressive patients. This method is proven safe, effective and decreases the likelihood for restraints. Among properly trained physicians this process takes less than 5 minutes. Just follow these “10 Commandments.” [spacer height=”20px”] Respect personal space. 2 arms length. Do not be provocative. Body language is important. Do not […]

Sugar the Rim

Posted on August 23, 2016 by Randy Sorge

“Want to hear the funniest therapy that actually works?” – Dr. Ben Schnapp, former Chief Resident extraordinaire [spacer height=”20px”] It was my first month of intern year, and I had just presented a patient with a recurrent rectal prolapse. Ben Schnapp, the senior resident, was delighted to show me what he said was the “the funniest therapy that […]

I hate Mondays!

Posted on August 22, 2016 by Randy Sorge

Garfield had it right. Mondays are the worst. [spacer height=”20px”] Want proof? Well, in 2004 the CDC published a survey measuring health care utilization among US Emergency Departments over a 10 year period. The results? ED visits peaked on Monday and then decline throughout the week, and Medicare patients were more likely to visit the ED on […]

Name that plethoric structure…

Posted on August 19, 2016 by Jeff Nusbaum

We are all familiar with the RUSH exam (see Dr. Weingart’s original article if you’re not). Since it’s been a recurring theme this week, we are going to focus on the IVC measurement of the spontaneously breathing patient. This will not be a discussion of which method of volume status measurement is superior (i.e. leg […]

The Matt Egan’s Wrist Memorial Radiology Pearl

Posted on August 18, 2016 by Jeff Nusbaum

Name that fracture, ideal imaging modality, and treatment including indication for operative repair: That would be a classic scaphoid fracture. It should ideally be imaged first with a three-view x-ray (AP, lateral, and scaphoid view – 30 deg extension, 20 deg ulnar deviation), but an MRI is the most sensitive for occult fractures. CT with […]

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DKA without the ICU

Posted on August 16, 2016 by Jeff Nusbaum

As we discussed yesterday, the treatment algorithm for DKA is fairly straightforward with a few subtleties we rarely appreciate, until now. Yesterday we focused on fluids, today we move on to the insulin. Can we offer the patient anything else beside an insulin drip? Obviously the answer is yes, or else this pearl wouldn’t exist. […]

Diluting your sugar

Posted on August 15, 2016 by Jeff Nusbaum

Last week, we closed out the week by discussing the dischargable, ‘benign sugars,’ but what about when you have the legit ‘sugars.’ We’re talking about DKA. While the algorithm for DKA is fairly straight forward – fluids, insulin, replete lytes prn, admit / ICU consult, there are some often under appreciated subtleties we neglect in […]

The oft forgotten ‘centesis

Posted on August 12, 2016 by Jeff Nusbaum

Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis: Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion Contraindications: severe clotting abnormality (relative) Complications: Ptx, cough, infection, hemothorax, re-expansion pulmonary edema, air embolism. Technique: No specific technique has been shown to be superior […]

Doc, I got the sugars, I cannot go home? Or can I…

Posted on August 11, 2016 by Jeff Nusbaum

Before answering that question, I need to acknowledge EM topics (http://www.emtopics.com/article-a-day/2016/discharge-glucose-level-is-not-associated-with-return-to-ed) for bringing this important article to my attention since this is nearly a daily occurrence in our ED. So, do you need to lower blood sugar to a magical, non-evidenced based threshold prior to discharge? Like everything, the answer is…. It depends, but in […]

Tachypnea, Bradypnea, platypnea and orthodeoxia. Oh my! Wait what?

Posted on August 9, 2016 by Jeff Nusbaum

We are all too familiar with tachypnic and the occasional bradypnic patient (i.e. narcan deficient) rolling through resus, but rarely do we come across platypnic and orthodeoxic (except for yesterday). In order to come across them, you need to know what they are, so here we go. Platypnea is defined as dyspnea in the upright […]

Is that really necessary? Pretreatment for RSI

Posted on August 8, 2016 by Jeff Nusbaum

Intubating a patient with a suspected head bleed is one of the highest risk situations we encounter as ED physicians. A failed attempt with enough airway manipulation can potentially increase ICP and have profound negative effects on patient outcomes. EM dogma, perhaps antiquated, dictates pretreatment with an opiate, typically fentayl, and lidocaine. But is the […]

ROID RAGE Pt 2

Posted on August 5, 2016 by Randy Sorge

If yesterday’s post on Roids didn’t get you jack’d then maybe today’s will! Here’s part deuce – Topical Steroids Spoiler alert – if you are using 1% hydrocortisone for every rash everywhere then you are likely underdosing! Dope up your knowledge with this killer chart. [spacer height=”20px”] [pdf-embedder url=”http://sinaiem.org/wp-content/uploads/2016/08/pdfresizer.com_2016-08-05_22-50.pdf”] [spacer height=”20px”] References: Ference JD, Last AR. Choosing topical corticosteroids. Am Fam […]

ROID RAGE

Posted on August 4, 2016 by Randy Sorge

Summer’s here! Time to hit the gym and review your steroid-knowledge. What’s the difference between prednisone/prednisolone/methyprednisolone again? Well, I’ll give you a hint… its not a pre/post work out fix! [spacer height=”20px”] Check out this chart below for a quick review. [spacer height=”20px”] [pdf-embedder url=”http://sinaiem.org/wp-content/uploads/2016/08/cortisone-chart.pdf”] [spacer height=”20px”] References: Tintinalli’s 7 edition, Chapter 132 http://www.nadf.us/downloads/adrenalhormone.pdf

Lumbar Puncture Pearls

Posted on August 2, 2016 by Randy Sorge

Lumbar punctures (LPs) can be tricky even for an experienced provider. Here are some pro tips to help you look like an all-star! Set up: The LP tray contains only a small amount of lidocaine (~3mls). If you need to make a second attempt in another intervertebral space you may not have enough remaining anesthetic. Bring […]

Kids eat the darndest things!

Posted on August 1, 2016 by Randy Sorge

Did you know you can use a regular old metal detector to rule-in a metallic swallowed foreign body in children? It’s true! Several studies have been published in The Journal of Accident and Emergency Medicine out of The Royal Hospital for Children located in Glasgow, Scotland. In one large prospective study, 186 children presented to the ED […]