Why Henderson and Hasselbalch Belong in the ED

the_big_question_9192If you’re like me, you learned and then promptly forgot the Henderson Hasselbalch equation (HH eq) in medical school.1 After all, in clinical rotations it was never invoked, and our patients seemed to have fared well without it. So why bring up the topic now?

Medicine is changing. The ubiquitous nature of computing allows a level of sophistication exponentially greater than before. To a large extent we’re freed from much of the onerous work of rote memorization. In the ideal, that should free us to be more thoughtful about the way we approach our work and to have a deeper understanding of health and disease. Going forward, medicine will become increasingly computational. With that in mind, I’ll make three points about the HH eq.

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Mythbusting the Banana Bag

bananaWe’re all pretty familiar with the banana bag: intravenous (IV) fluids with the addition of thiamine, folic acid, multivitamins, and sometimes magnesium. Banana bags are commonly utilized in patients at risk for alcohol withdrawal symptoms or those who present to the emergency department (ED) acutely intoxicated.

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US4TW Case: 30M with Blunt Abdominal Trauma

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In today’s case, a 30-year-old male is brought in after blunt trauma from a high-speed MVC.

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Blunt Chest Trauma: Validation of the NEXUS Chest Rule

Rib fx Chest CTWe commonly see patients who have some form of blunt chest trauma. This is the result of motor vehicle collisions, falls, and a myriad of other traumatic events. The decision to perform thoracic imaging can be difficult. Chest xray (CXR) and/or chest CT? In fact, studies have shown that emergency and trauma physicians often disagree 28-40.9% of the time about which patients require a chest CT following blunt trauma. 1,2

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Bleeding and Hemophilia in the Pediatric ED

hemophilia-causes-2726

Bleeding as a chief complaint in the pediatric emergency department is something that many healthcare providers will come across. Some of these children may have inherited bleeding disorders that we must be aware of in order to provide the best care possible. Below is a basic review of hemophilia and what we should know and do in the emergency department.

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US4TW Case: 28F with Shortness of Breath

Welcome to the inaugural post for an exciting new ultrasound-based case series called “Ultrasound For The Win!” (#US4TW). In this peer-reviewed case series, we will focus on real clinical cases where bedside ultrasound changed the management or aided in the diagnosis. In our first case, we present a 28-year-old female with shortness of breath.

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Small bowel obstruction: Diagnosis by ultrasonography

SBOuprightA 64 year old man with an extensive history of abdominal surgeries presents to the emergency department with abdominal pain and vomiting. Because you suspect a bowel obstruction, you bring an ultrasound machine to the bedside prior to the completion of any laboratory testing or other imaging. A curvilinear probe in the abdominal mode setting was used to scan in all four quadrants of the abdomen looking in both the sagittal and transverse planes.

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