Core Emergency Medicine

Ultrasound Guided Lumbar Puncture

How ultrasound can help with this common ED procedure- the lumbar pucture.

Updates in High dose Insulin and Euglycemia Therapy (HIET) for the treatment of Beta-adrenergic Receptor and Calcium Channel Antagonists Overdose

An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose.

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Podcast 186.0: Hypocalcemia

A quick primer on hypocalcemia in the ED.

Hosts:
Joseph Offenbacher, MD
Audrey Bree Tse, MD

Podcast 185.0: Anticoagulation Reversal

How and when to reverse anticoagulation in the bleeding EM patient.

Hosts:
Joe Offenbacher, MD
Audrey Bree Tse, MD

Core Procedures See More →

Fiberoptic Intubation

Our NYU Bellevue EM docs cover the basics for this high-yield, potentially lifesaving procedure.

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Cordis Insertion into the Femoral Vein

How to insert a cordis/ introducer sheath into the femoral vein with Dr. Weber and Dr. Adams!

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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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: Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma

Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma J Surg Res., 2021

Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Prehospital hypotension is one of those criteria.
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: Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area

Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area Pediatr Emerg Care, 2021

Children with knee monoarthritis from Lyme disease and septic arthritis can have similar presentations. The early disseminated stage of Lyme disease,
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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?