Core Emergency Medicine

Dental Trauma

How to classify, diagnose, and manage various types of dental trauma seen in the ED.

Akathisia

An overview of akathisia: easily missed and easily exacerbated in the ED.

Core Podcast See More →

Episode 170.0 – Septic Arthritis

An overview of septic arthritis.

Hosts:
Audrey Bree Tse, MD
Brian Gilberti, MD

Episode 169.0 – Febrile Seizures

A look at the most common type of seizures in the young pediatric population.

Hosts:
Brian Gilberti, MD
Audrey Bree 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 →

Sep272019

Hi CoreEM Community-

This isn’t a usual blogpost but we just wanted to let you know that NYU Bellevue EM Department is looking to hire new faculty for 2020!!!  It’s an amazing place here with a chance to work with some fantastic residents and inspiring colleagues and treat an impressive breadth of patients,
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Aug092019

There is a man living in New York City who once suffered a traumatic brain injury and is now frequently brought into our ED by EMS with a chief complaint of “seizure.” Often providers order labs, imaging and medications, prescriptions he doesn’t fill and make clinic appointments he never attends. He appears disheveled so many assume he is addicted to alcohol and has seizures due to withdrawal.
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Jun252019

The new 2019 PEM Guide has been released! 183 PEM topics covered concisely in this free, point of care reference.

Download the PDF

Access the Apple Book

“PEM (Pediatric Emergency Medicine) Guides was developed as an online, point of care resource for the residents and medical students who work with us in our pediatric emergency departments.
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Core Journal Club See More →

: Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis

Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis Ann Emerg Med, 2019

Syncope accounts for a high number of hospital visits yearly and is associated with significant cost. Various syncope decision tools can help clinicians decide which patients are safe to discharge home when no serious cause is identified in the emergency department (ED). 
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: Dexamethasone in Adults with Bacterial Meningitis

Dexamethasone in Adults with Bacterial Meningitis NEJM, 2002

Morbidity and mortality rates are high among adult patients with acute bacterial meningitis especially those with pneumococcal meningitis. Animal studies have shown that bacterial lysis occuring with antibiotic treatment leads to inflammation in the subarachnoid space and that treatment with dexamethasone,
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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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