Core Emergency Medicine

Leukemia

A look at ED management for pediatric patients with suspected leukemia.

Hand, Foot, and Mouth Disease

An overview of this common and highly contagious pediatric disease.

Core Podcast See More →

Episode 181.0: Subarachnoid Hemorrhage

We discuss EM presentation, diagnosis, and management of subarachnoid hemorrhage.

Hosts:
Mark Iscoe, MD
Brian Gilberti, MD
Bree Tse, MD

Episode 180.0: Urine Tox Screens

We discuss the (F)utility(?) of ED Utox screens with our very own Dr. Phil DiSalvo.

Hosts:
Bree Tse, MD
Brian Gilberti, 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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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?