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Limit potassium infusion to 10 mEq/hr for peripheral IVs because of pain, extravasation, and phlebitis. Central lines can infuse faster at rates of 20 mEq/hr, requiring cardiac monitoring. What if a critically ill patient doesn’t have a central line but needs rapid repletion?

Trick of Trade: Place 2 peripheral IVs each infusing as fast as 10 mEq/hr. Place on a cardiac monitor. Pearl from Dr. Munz at #emconf.

Great review of hypokalemia https://emcrit.org/ibcc/hypokalemia/ (link in bio)

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #endocrine #hypokalemia
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Ask your patient with eye pain about contralateral photophobia. “Does it hurt your painful eye when I shine a light in your unaffected eye?” If so, it’s highly likely IRITIS. Shining a light on the normal eye causes consensual pupil constriction, which causes ciliary body pain in the other eye with iritis👏 Dr @kgondy

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #ophthalmology #eye #iritis #photophobia
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Giving Rhogam to Rh negative pregnant patients is not indicated for fetus <8 gestational weeks because RhD antigen is not present yet. Alloimmunization thus is not an issue. However if in doubt of estimated gestational age, give Rhogam. Note that the Ob and EM guidelines differ in this. ACEP says give it to all first trimester patients. ⭐️ Dr @antnard10

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #obgyn #rhogam
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When prescribing phenazopyridine (aka Pyridium) for urinary symptoms such as dysuria or frequency, be sure to warn them that their urine may turn orange or red. Otherwise they may think they’ve developed hematuria! 🩸

Nice 🕵️‍♂️ work, student Dr. @ijx_vma

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #pyridium #uti
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Don’t forget about hypertriglycerides as cause of pancreatitis. Often the blood sample will be a little milk why and be labeled as “lipemic”. Goal triglyceride serum level <500 mg/dL, because of the risk of necrotizing pancreatitis and organ failure. 👏 Dr @ktagooma !

With greater severity, add insulin IV in the setting of hyperglycemia. Can also add plasmapheresis to the treatment regimen. Reference: UpToDate

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #gi #pancreatitis #lipase #hypertriglyceride
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Watch out for extensor tendon injuries of the finger. They are often missed. A tip to remember:

- Extensor DIP trauma - check for mallet finger

- Extensor PIP trauma - check Elson’s test

Elson test video: https://www.aliem.com/elsons-test/ (link in bio). ⭐️ Dr. Tsolinas

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #finger #extensortendon #orthopedics #mallet #elson
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Too impatient to wait for a chest X-ray to look for pulmonary edema? Use a bedside ultrasound to look for B lines, which are transient, hyperechoic vertical lines that extend from the lung pleura to the bottom of screen of at least 16 cm depth. Be sure to set your depth far enough. Abnormal is having 3+ B lines in a region. 👏 Dr @eppslane and @mattroces

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #pocus #ultrasound #pulmonaryedema

Read more: https://www.pocus.org/resources/lung-ultrasound/ (link in bio)
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#InternTip

If giving oral antibiotics to patients to be discharged, give the first dose in the ED. It often takes 48-72 hr to take full effect. Save them some time since it takes a while to get to pharmacy… especially if presenting in the middle of the night. 👏 Dr. Woodson

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #newintern #antibiotic #pharmacy
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Why learn the Fascia Iliaca regional block for hip fractures? Many studies report decreased opioid requirements and opioid-related complications (respiratory depression, nausea, delirium). This is especially important as older patients (age >55 yr) no longer warrant routine preoperative traction per 2021 American Academy of Orthopedic Surgeons strong recommendation. It’s easier to induce fracture pain, now that the hip is less rigidly immobilized.

Why is traction no longer a routine practice? Traction in older patients leads to complications such as pressure ulcers, UTIs, pulmonary problems, constipation) while providing no added benefit compared to 1 day of preop pillow position splint.

AAOS details: https://www.orthoguidelines.org/guideline-detail?id=1700&tab=all_guidelines (link in bio)

@aaos_1

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #geriatric #hipfracture #aaos #orthopedics #regionalblock #fasciailiaca
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A patient presents with cheek swelling and pain after being punched. Should you order a CT scan to assess for a zygomatic arch fracture? These patients are inevitably tender over the area from the soft tissue trauma.

Trick of the Trade: Palpate the normal skin inferior to it and push upward to press on the arch to elicit tenderness. You can alternatively use a Q tip to do this instead of your finger for more pinpoint palpation. Excellent shift with Dr. @kirstend23

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #ENT #facialtrauma #zygomaticarch
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Do you give a dose of an antiemetic medication concurrent with the IV opioid in the ED? I’ve seen this being done occasionally and the theory makes sense, given the nausea-inducing effects opioids for some patients.

Based on a 2022 Cochrane Review of 3 studies (all using metoclopramide), there was no difference in needing a rescue medicine for vomiting. Although the studies only involved one antiemetic agent, the authors make a more general recommendation that a prophylactic dose of an antiemetic is unnecessary for opioid-induced vomiting.

“Metoclopramide did reduce the severity of nausea compared with placebo (MD −0.49, 95% CI −0.75 to −0.23; low-certainty evidence) but did not reduce the need for rescue medication (RR 1.86, 95% CI 0.17 to 20.16; low-certainty evidence).”

2019 AAEM Clinical Practice Statement: Similar recommendation. They mention a caveat - to inquire about prior opioid-induced vomiting or history of motion sickness (may have some benefit with prophylactic antiemetic).

And then the issue of generalizability to other antiemetics comes up. Does this hold true for ondansetron? The evidence is unclear. For now I don’t use prophylactic antiemetics.

What’s your practice?

Cochrane: https://www.cochrane.org/CD013860/SYMPT_prophylactic-antiemetics-adults-receiving-intravenous-opioids-acute-care-setting (link in bio)

AAEM Statement 2019: https://www.aaem.org/UserFiles/file/PostCPCAntiemetic.pdf @aaeminfo

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #cochranereview #metoclopromide #opioid #pharm #medication
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Acute abdominal pain + older age (>=65 years) = likely CT imaging

Up to about 1/3 of these patient have a surgical etiology. So much can hide or look benign such as AAA, biliary disease, bowel obstruction, etc. Consider CT imaging as your default mindset unless you can demonstrate a more benign condition. 👏 Dr. J Lee @0205_1019 [UpToDate]

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #abdominalpain #older #elder #ct
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Peritonsillar abscess (PTA) drainage trick of the trade. A tongue blade + light source = laryngoscope. Even better, use video laryngoscopy so that others can see the procedure, especially if you are supervising a trainee doing the procedure.

UCSF High Risk EM Hawaii #hrem22

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #peritonsillarabscess #pta #laryngoscopy #ent
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Concerned about cauda equina syndrome? Earliest clinical finding is URINARY RETENTION. When patients get urinary incontinence, it’s usually from overflow incontinence from existing retention.

Check the bladder post void residual (PVR) using the ultrasound. If it’s <200 mL, there’s a negative predictive value of 97%.

https://pubmed.ncbi.nlm.nih.gov/31479434/ (Spine 2019, link in bio)

UCSF High Risk EM Hawaii #hrem22

#postitpearls #foamed #emergencymedicine #nursepractitioner #physicianassistant #emresident #postit #caudaequinasyndrome #pvr #ultrasound #pocus #neurosurgery
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