Core Emergency Medicine

Guillain-Barré Syndrome

An overview of a rare but must-not-miss diagnosis in the ED: Guillain-Barré Syndrome.

Diarrhea

An overview of one of the most common complaints that comes into our ERs.

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Episode 177.0 – Hemoptysis

An overview and management tips of hemoptysis in the ED.

Hosts:
Brian Gilberti, MD
Audrey Bree Tse, MD

Episode 176.0 – Pneumonia Updates

We go over the recent updates in the workup and management of pneumonia.

Hosts:
Brian Gilberti, MD
Audrey Tse, MD

Core Procedures See More →

Elbow Dislocation

An overview of elbow dislocations, how to examine them, and suggested techniques for reduction by Dr. Laura Weber

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Push-Dose Pressors

A brief video reviewing how to prepare and administer push-dose epinephrine and push-dose phenylephrine.

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Core Blog See More →

Jan292020

Learning to interpret ECGs is not easy – but there’s a world of help out there.

Authors: Bennett J, Rhee D, Wagh A, Pusic M, Tse AB.

Being able to efficiently and accurately read an ECG is an important yet very difficult skill to learn. Online resources can help you improve your abilities at any learner level;
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Dec102019

“There are some things you learn best in calm, and some in storm.”

– Willa Cather

Over the past several years, I’ve thought a lot about what to say during the immediate moments after a failed cardiac arrest or traumatic resuscitation. When the rush of adrenaline comes to a screeching halt and all that is left is a deafening silence,
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Nov262019

The new version of the PEM CARS iBook (V3.0, 2019) has been released! 200 comprehensive, critical article reviews on PEM literature available for free.

Download the PDF

Access the Apple Book

Congratulations and many thanks to the NYU/Bellevue Pediatric Emergency Medicine fellows and faculty that have put in a considerable amount of effort to make this happen.  
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Core Journal Club See More →

: Pulmonary Complications of Opioid Overdose Treated with Naloxone

Pulmonary Complications of Opioid Overdose Treated with Naloxone Annals of Emergency Medicine, 2020

Pulmonary complications after opioid overdose include: non-cardiogenic pulmonary edema, aspiration pneumonia/pneumonitis and acute respiratory distress syndrome. Multiple mechanisms have been proposed for these complications.
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Core Cases More Cases →

CC

Nausea, vomiting, and abdominal pain

HPI

Acid-Base Workshop: At the beginning of the conference year, multiple faculty members ran a workshop on acid-base abnormalities where we worked on identifying acid-base disturbances, determining primary respiratory or metabolic abnormalities, causes of such disturbances, and if compensation was appropriate. Perhaps one of the most challenging types of patients we encounter with an acid-base disturbance is an acidemic patient who we believe requires intubation. Below you will find a variety of resources on acid-base disturbances and more specifically, intubation and ventilation in this patient population. Read the case, consider reviewing the resources below, and think how you would approach this tenuous patient.


The Case:

A 23 yo F with a PMH of poorly controlled T1DM presents to your ED complaining of nausea, vomiting, and abdominal pain. She ran out of her insulin 3 days ago and didn’t have the funds to refill it. Her FS is 415 on POC testing.

Physical Exam

Vitals: 123/80, HR 120s, O2 98%, RR 32, Temp 98.2

General: sleepy but arousable to voice

HEENT: dry mucous membranes

Chest: CTAB, kussmaul breathing

Cardiac: regular rhythm, tachycardic

Abdomen: soft, NTND

Extremities: MAE

Labs

VBG: 7.03/14/65, Calculated Bicarb 5

BMP: 132/4.3/99/3/20/.09>423


What next?

You hang fluids and start an insulin drip, but the patient becomes progressively lethargic and has vomited twice despite anti-emetics. You decide you need to intubate. What next?

Questions

  1. What are the risks of intubating this patient?

  2. What would be your intubation strategy? Method, intubation medications, and things to pay attention to?

  3. Would you consider giving any additional medications (apart from paralytics or sedation medications) prior to intubating? If so, why, and what would be the dosing?

  4. What would be your ventilator settings?

More Info

Basics:

Aliem- Deciphering Acid Base Disorders

Case Content:

Case of the Month, Acidemia

Intubation/Ventilation FOAM:

Critical Care Updates: Resuscitation Sequence Intubation – pH Kills (Part 3 of 3) Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis Simplifying Mechanical Ventilation – Part 3: Severe Metabolic Acidosis

Peer Reviewed:
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