The Art of Syringe Labeling in the ED

The ‘look-alike, sound-alike’ nature of many drug appearances and names is problematic. In high-stress environments such as the Emergency Department (ED), potential disasters can arise if “drug swap” or other medication errors occur. Drug swap is the accidental injection of the wrong drug.¹ The anesthesiology literature contains several published reports presenting various ideas on how to properly label syringes used in the operating room to reduce medication errors. Techniques include color-coding the labels,² labeling of the plunger,³ double-labeling,^4,5 and specific placement of the labels on the syringe.⁶

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-02-19T18:49:33-08:00Mar 16, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|

Ultrasound for Verification of Endotracheal Tube Location

In patients undergoing emergent tracheal intubation, there is currently no universally accepted gold-standard test to confirm the location of the endotracheal tube (ETT).¹ End-tidal carbon dioxide (CO2) detection is the best of the tests that are routinely utilized to confirm ETT placement, however, it has been shown to have an error rate as high as 1/10 for proper determination of ETT location in emergency intubations.² As a result, multiple modalities are necessary to confirm ETT location, which can delay mechanical ventilation and other treatments. The lack of a single, reliable test to confirm ETT placement can potentially lead to confusion regarding the location of the tube. This confusion can result in both unrecognized esophageal intubations (“false positive”), as well as successful tracheal intubations that are subsequently removed (“false negative”), subjecting the patient to further unnecessary attempts at airway management. Both scenarios can lead to disastrous consequences.

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By Mark Favot, MD|2021-01-05T13:56:52-08:00Mar 2, 2015|Critical Care/ Resus, Expert Peer Reviewed (Clinical), Ultrasound|

Ultrasound For The Win: 46F with Right Abdominal and Flank Pain #US4TW

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 a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 46-year-old woman presents with acute right-sided abdominal and flank pain.

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By Jeffrey Shih, MD, RDMS|2021-03-10T10:02:08-08:00Feb 24, 2015|Expert Peer Reviewed (Clinical), Genitourinary, Ultrasound, Ultrasound for the Win|

Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?

Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur in up to 30% of cancer patients at some point during the disease.^1–3 Clinical manifestations include mental status changes (which may progress to coma) and renal impairment.³ These patients may be classified based on both type and severity. Therapies for managing MAH emergently should focus on correcting the underlying mechanism, as outlined below with their respective causes:³

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By Meghan Groth, PharmD, BCPS|2016-12-19T12:59:11-08:00Feb 19, 2015|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Tox & Medications|

Ultrasound For The Win: 22M with Scrotal Pain #US4TW

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 this case, a 22-year-old man presents with acute scrotal pain.
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By Jeffrey Shih, MD, RDMS|2017-07-19T00:08:38-07:00Feb 12, 2015|Expert Peer Reviewed (Clinical), Genitourinary, Ultrasound, Ultrasound for the Win|

Anti-NMDA-Receptor Encephalitis

Anti-NMDA-receptor encephalitis is a severe and treatable immune-mediated disorder which presents with a rapid progression of psychiatric and neuropsychiatric symptoms. Although only first reported as a diagnosis in 2007, an exponential number of cases have since been described, suggesting that the disease is not rare but rather under-diagnosed. Emergency physicians play an important role in recognizing this disorder, as prognosis is largely dependent on early treatment with immunotherapy.