Trick of the Trade: Nasopharyngeal Oxygenation

By |Categories: Critical Care/ Resus, Tricks of the Trade|

A 76-year-old obese male with a history of severe COPD presents to your emergency department (ED) in acute respiratory distress. The patient’s large beard prevents an adequate seal with the NIV (non-invasive ventilation) mask, and the patient continues to desaturate. You are fairly sure that this patient will be a difficult airway and optimizing oxygenation prior to and during your intubation attempt would be ideal. Now what? […]

Upper Gastrointestinal Bleeding: Evidence-Based Treatment

By |Categories: Gastrointestinal|

Upper gastrointestinal bleeding remains a common reason for emergency department visits and is a major cause of morbidity, mortality, and medical care costs. Often when these patients arrive, the classic IV-O2-Monitor is initiated and hemodynamic stability is assessed. Some of the next steps often performed include: Determination of the site and rate of bleeding (upper vs lower) Initiation of proton pump inhibitors (PPIs) Somatostatin analogs if variceal bleeding is suspected Prophylactic antibiotics Packed red blood cell (PRBC) transfusion for low hemoglobin and hematocrit levels What is the evidence for these treatments, and do they affect morbidity and mortality? […]

Ocular Ultrasound: Retinal Detachment and Posterior Vitreous Detachment

By |Categories: Ophthalmology, Ultrasound|

It’s 3 am in the middle of your busy night shift and you begin your evaluation of a 65 year-old woman with diabetes with several hours of unilateral flashes of light in her left eye. Her visual fields seem normal, but you are unable to see her fundus with your direct ophthalmoscope. Luckily, you remembered the teaching from your ultrasound rotation during residency. […]

Trick of the Trade: Fist Bump to Reduce Pathogen Transmission

By |Categories: Infectious Disease, Tricks of the Trade|

Handshaking has been practiced as far back as the 5th century BC and used today as a common way of greeting others. In the hospital setting this occurs multiple times throughout the day. Many alternatives to the handshake have been developed and utilized, but they have failed to replace the handshake as a form of greeting. Nosocomial infections have been identified as a major preventable complication of inpatient care and one of the most important initiatives to reduce this is hand hygiene. The authors of this study propose the fist bump as a safe and effective way to avoid hand-to-hand contact and therefore reduce transmission of infection. 1 [...]

Is the Patient Sober? Clinical Sobriety versus Blood Alcohol Concentration

By |Categories: Medicolegal, Tox & Medications|Tags: |

There is significant practice variability when providers are asked to determine if a patient is intoxicated. Some providers will evaluate a patient to determine if a patient is “clinically sober”, while other providers will rely on a patient’s blood alcohol concentration (BAC) to evaluate a patient’s level of intoxication.  There is very little data to suggest that either approach is superior; however, both practice patterns have significant limitations and carry a certain degree of medicolegal risk.  […]

Did you know that there are new Tox/Meds PV Cards?

By |Categories: ALiEM Cards, Tox & Medications|

Don’t know when to use ketofol for procedure sedation or if you can rapidly load phenytoin? See the new PV-Plus Cards on AgileMD for free on any smartphone/tablet/desktop. Other topics include: Thrombolytics for submassive PE Vasopressor agents for the hypotensive patients Tramadol t-PA for codes Searchable Emergency Drug Card with dosages for Adults and Pediatrics UPDATE Jan 1, 2018: The PV Cards are no longer on AgileMD.

Amylase Level for Pancreatitis: Stop doing it

By |Categories: Gastrointestinal|

A patient actively vomiting is wheeled into your ED. Within minutes IV access is obtained, and your nurse asks what tests and medicines are wanted. A liter of normal saline, ondansetron, and an H2 blocker are easy, but what labs to order? I think we can all agree on a metabolic profile to look at electrolytes and liver function tests, and a lipase level to assess for pancreatitis. But what about an amylase level? Originally from Clinical Monster blog […]

Blood Cultures in Pneumonia

By |Categories: Infectious Disease, Pulmonary|

A 75 year old woman is found to have pneumonia. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pneumonia with Ceftriaxone and Azithromycin, and admitted. Unfortunately, the admitting service points out that no blood cultures were drawn! What is the evidence for this? Originally from Clinical Monster blog […]