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Name That Poisonous Beast (part 3)
Posted onPart 3 of “Name that Poisonous Beast” is ocean-themed. Name this poisonous beast! A) And it’s floaty colleague: B)
You’re treating an asthmatic 22-year-old. You give 5 back-to-back nebs, steroids and mag. When you reassess, she’s moving air better with minimal wheezing, but more tachypneic. Additionally, her lactate has climbed from 2 to 6.8 in 2 hours. She’s not hypoxic and there are no signs of hypoperfusion. What gives? This patient has albuterol-induced hyperlactatemia. […]
A 54-year-old suicidal patient presents to the ED after an unknown ingestion. Vitals are 98.9, 102, 18, 111/74, 97%, fs 98. She is somnolent but arousable. You send labs and find that the patient has an anion gap of 20, osmolal gap of 62, lactate of 8.8, ethanol of <10, and negative ketones. Q: What […]
Do central line-associated bloodstream infection (CLABSI) rates differ based on whether they were placed in the ED versus the ICU? A recent article published in Academic Emergency Medicine attempted to answer this very question. Central lines inserted in the emergency department are often cited as being “dirty” or not having the same sterile precautions that […]
aVR is the neglected cousin of the other ECG leads. He doesn’t always make sense, nobody really understands him, and he usually sits alone at the dinner table. This is to the detriment of those who ignore him, as aVR can easily lead clinicians down the correct clinical pathway if used correctly. There are several […]
I once lost a 25 year old on a cardiac shift. Later, after the shift ended, I was thinking of his whole life gone and wondering if I could have done more, performed more excellently. I wondered if another resident would have lost him if in my place.” “I had a woman in her 40s’s […]
“Lack of support in hospital/department. Social isolation, Lack of free time. Loss of confidence in your own abilities.” “…the fact that everything is on you…to push patients, to draw labs, to call consults, to juggle everything and have excellent charting and in the end if everything goes wrong its’ ultimately totally your fault. Our jobs […]
“I’m worried about losing my sense of humor…sometimes situations make me feel I’m losing that and then I’m just bitter.” “I actually think I’ve retained my compassion and empathy well…I think I have gained skepticism perhaps in exess of what is healthy.” “My sense of tragedy. Not just in the classic sense of someone dying […]
Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency department. The thought of potentially missing a sentinel bleed from an aneurysm or AVM is something that keeps […]
Today’s pearl is short and sweet. Here’s a breakdown of common radiologic studies performed in the emergency department along with their sensitivities and specificities according to the available literature. You may be surprised by some of the findings and lack of evidence for commonly obtained studies. Study Sensitivity/Specificity (%) Plain Film Sensitivity/Specificity (%) CT Sensitivity/Specificity […]
