Grandma v. Turkey…

Everyone is enjoying a fabulous Thanksgiving dinner when suddenly Grandma starts complaining that she can’t swallow, that something’s stuck, why didn’t you cut the turkey into smaller pieces, this is your fault, and now she’s not feeling thankful at all! It got dark, fast. She is in no respiratory distress, tolerating her secretions, and you […]

Status – but What if the Seizing Doesn’t Stop?

Status epilepticus is one of the few neurologic emergencies.  Many protocols for persistent status involve dosing with a benzodiazepine, then another benzo, then an antiepileptic medication, and finally, continuous sedation with intubation.  The Sinai protocol is found here. But what if the seizing doesn’t stop?  How long can we wait for these medications to work […]

Can’t Sedate Me! I’m Allergic to Haldol.

A 24yo M with hx schizophrenia presents to the ED agitated, threatening staff and making gestures of self-harm.  You are unable to verbally deescalate him and go to order some sedative medication.  However, on his chart you see “Allergy: haloperidol”.  What does this mean?

A Pain in the Back – Do Patients Need More Than Nsaids?

A recent double-blinded, RCT from JAMA investigated the relative efficacies of naproxen + placebo, naproxen + cyclobenzaprine and naproxen + oxycodone/acetaminophen on functional impairment in acute onset (<2 weeks), non-traumatic, non-radicular low back pain in the non-elderly (<64).  Their findings: Of 390 patients that met inclusion criteria, there was no added benefit on functional impairment […]

No Plasmalyte in Cms Sepsis Bundle: Does This Matter?

CMS recently produced a new sepsis measure/bundle that has many EM and critical care docs up in arms.  I’m not going to focus on their definition of sepsis (save your rage for later), but instead on the fact that their definition of resuscitative crystalloid specifies ONLY LR or NS.  So to be truly within guidelines, […]

September 2024
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