Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium to review the physiology of fluid resuscitation in the setting of hyper K (per request by Dr Hickey). This has been debunked […]
You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered by cells:How do our treatments shift K+ intracellularly? … Key: Na-K-ATPase! 3Na+ out, 2K+ IN! And stimulated by the β2 and insulin […]
You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate was in the 150s — no time for a full set of vitals or an EKG. You adeptly obtain these; the […]
Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear” due to the increased likelihood of developing after prolonged submersion in water, AOE can be caused by trauma, foreign bodies […]
Your patient in intake is miserable. Doubled over, complaining of pain everywhere, sweating, ill-appearing but not unstable. He tells you that the last time he used heroin was two nights ago, and he is asking for help. How do you treat this patient? And how do you determine what medication would be appropriate? There are […]
As the late spring rains have begun to fade and the temperature rises mercilessly into the 80s and beyond, summer is finally upon us. And with summer comes a host of diseases for the emergency physician to consider. Heat stroke, mosquito- and tick-borne illnesses, chicken pox, an expanding measles outbreak…and a less threatening cause of […]
We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know well these faceless interactions with a human reminding you to renally dose your Zosyn, stop ordering the bicarb drip that way…and […]
You’re on a lovely amble through the backcountry when suddenly you see smoke rising nearby and catch a whiff of a familiar scent that throws you back to your med school OR days: burning flesh. You quickly find one obtunded, severely burned hiker who inadvertently set fire to his camp. After a quick airway assessment […]
Perhaps never explained so clearly, Cisewki and Alerhand’s article on EPSS is a wonderful read. Bottom line to remember: EPSS > 7 mm was 87% sensitive and 75% specific at identifying reduced EF (<50%). This is the cutoff generally used to point to an abnormal EF (but isn’t it all about stroke volume, really?)
Whether it’s asthma, a U.R.I., or post nasal drip as the cause, cough is a common enough complaint encountered by emergency physicians everywhere. Of course you must always rule out the dangerous causes of cough (PNA, Measles, PE, Heart failure, CHF, lung cancer PVCs ) but once thats done, you still have to treat the […]
