Core Emergency Medicine

Post-Partum Hemorrhage

This post explores post-partum hemorrhage with a focus on identification and management.

Salicylate Toxicity (Salicylism)

This post explores the presentation, diagnosis and management of salicylate toxicity.

Core Podcast See More →

Core Procedures See More →

Digital Nerve Block

This is a brief video detailing how to do regional anesthesia for the fingers.

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How to Apply a Pelvic Binder

This post discusses the application of both a commercial pelvic binder as well as a sheet for pelvic stabilization.

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Core Blog See More →

May042018

Teaching on a clinical shift can sometimes be difficult: it’s busy, everyone’s running around and it’s hard to capture a trainees attention. Recently, on twitter, Amal Mattu (@amalmattu) has been posting pictures of his white board teaching: discrete pearls written down and shared with anyone who walks by. The pearls are often prompted by patients presenting during that shift but they don’t have to be.
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Apr062018

“Code Blue in the waiting room!”

As my co-resident, attending, and I sprinted down the hall, I vividly remember thinking to myself that I probably shouldn’t be here right now. I was working upstairs in the surgical ICU. On a particularly slow overnight, I decided to head down to the ED to visit some friends.
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Nov172017

The Paradox

“Go take a break.” “Let me quickly pick up these two patients.” “Go grab some food and come back.” “I’m fine, I’ll just…” “Sanjay, get the hell out and don’t come back for fifteen minutes.”

It was my sixth overnight in a row. After having struggled for over 15 minutes with trying to place an ultrasound guided IV in a sickle cell patient,
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Core Journal Club See More →

: The VAN Assessment to Identify Large Vessel Occlusion Strokes

Stroke vision, aphasia, neglect (VAN) assessment - a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices J Neurointervent Surg, 2017

This review is cross-posted on REBEL EM.

Over the last three years, we have seen the rise of neurointerventional therapies for patients with ischemic strokes due to large vessel occlusions (LVOs).
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: SALT-ED: Balanced Solutions vs 0.9% Saline in the ED

Balanced Crystalloids versus Saline in Non-critically Ill Adults NEJM, 2018

Intravenous fluid administration is a staple of modern medical care. The advantage of crystalloid over colloid solutions is well established in the literature.
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Core Case of the Month More Cases →

Case: May 2018

CC

Malaise

HPI

45yo M with obesity, HTN, DM, GERD, EtOH abuse, presents feeling unwell and fatigued. Has mild HA, lightheadedness and for the past few days has been having polyuria with home FS in 300s. Was seen in ED yesterday with elevated FS, but given fluids with improvement in symptoms. Afterward, he saw his endocrinologist who adjusted his medications. Denies fever, abd pain, n/v/d, dysuria.

Physical Exam

BP 156/90, HR 101, RR 17, O2 99%, T 97.5F, FS 121
Gen: NAD, AAOx3
HENT: NCAT, EOMI, PERRL
CV: RRR, 2+ peripheral pulses 
Pulmonary/Chest: CTAB, no resp distress
Abdominal: Soft, NT/ND
Musculoskeletal: FROM, no edema
Neurological: No deficits
Skin: Warm and dry

Labs

CBC: 10 > 15 / 43 < 297, 65% Neut BMP: 138 / 4.8 / 105 / 12 / 15 / 0.6 < 135 VBG: 7.265 / 30 / 32 / 13.7, lactate 3.7 EtOH: <10

Questions

  1. What is your differential for this patient?

  2. What other lab test can confirm your diagnosis?

  3. How would you manage this patient?