About Timothy Peck, MD

ALiEM Blog Contributor
Emergency Medicine resident
Beth Israel Deaconess Medical Center
Founder, iClickEM
Co-Founder, Parzival

Trick of the Trade: External jugular tourniquet

Paitents can be a challenge when trying to obtain peripheral IV access. The vein may be collapsed from dehydration or scarred because of IV drug use or repeated cannulation. Before thinking about an ultrasound-guided deep vein IV or a central line, take a look at the external jugular (EJ) vein.

There are, however, a few problems that exist when trying to cannulate this site:
  • There is no tourniquet for the neck.
  • To distend the vein, you often need to put the patient in Trendelenburg, which may be uncomfortable or intolerable for some
By |2016-11-11T11:17:20-08:00Mar 5, 2013|Tricks of the Trade|

Modern EM: Case #4 – Palpitations

Case # 4: Palpitations

A 25 year old woman presents with palpitations, sweating, and shortness of breath since this morning. 6 days ago she had syncopized, was shocked out of V-tach by EMS, and eventually had a defibrillator placed for an unknown arrhythmia. Now, she feels her heart beating in her chest, looks diaphoretic, is tachypnic, but her pulse is 58 and regular.

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By |2016-11-18T10:03:19-08:00Apr 9, 2012|Cardiovascular, Social Media & Tech|

Modern EM: Case 3- Get your phones out

iphoneSometimes on off-service morning table rounds, I like to close my tired eyes and focus my ears past the voice of the attending to hear the chorus of hundreds of pieces of paper flipping, shuffling, crinkling, and folding.  It’s one way to pass the time when surgeons debate over issues they don’t already know the answers to. Another is to get your phone out, and help answer the questions with them.

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By |2016-11-11T18:51:02-08:00Apr 2, 2012|Social Media & Tech|

Modern EM: Case 1 and 2 – Strep Throat

A sister and brother, aged 7 and 14, respectively present with pharyngitis.  The 7F has sore throat, cough, fever, and post-tussive vomiting for 1 day.  She has posterior pharyngeal erythema, no lymphadenopathy, no exudate, no petechiae, and looks like a viral URI.

The 14M had culture confirmed GAS pharyngitis 3 weeks ago, was treated with PCN-VK and symptoms resolved.  Now, he’s in the ED with signs and symptoms of pharyngitis again, including dysphagia, fever, cough, posterior pharyngeal erythema, swollen tonsils, LAD, and petechiae on his hard palate.

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By |2017-03-05T14:18:48-08:00Mar 26, 2012|ENT, Social Media & Tech|