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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Background
The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of CT pulmonary angiography (CTPA) for diagnosis. However, despite these algorithms, there is evidence of increasing use of CTPA along with diminishing diagnostic rate (less than 10%).
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This post discusses tips for diagnosis of MetHb and pearls for management.
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Point of Care Ultrasound (POCUS) has gained wider use in resuscitation of patients presenting with cardiac arrest. POCUS can play an important role in determining the etiology of arrest as well as being used to determine the presence or absence of mechanical activity. The REASON study demonstrated that patients with PEA or asystole without cardiac activity on POCUS are extremely unlikely to survive to hospital discharge though this study did not investigate the more important question of a survival with a good neurologic outcome.
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This post reviews the most common suture types encountered in the ED along with indications for using different types.
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Each year approximately 790,000 Americans suffer an acute myocardial infarction (AMI) (Benjamin 2017). Traditional treatment for an acute myocardial infarction has included morphine, oxygen, nitroglycerine and aspirin (MONA) with interventions such as percutaneous coronary intervention providing more definitive management. There has been little data from randomized control studies that supports the use of oxygen in AMI.
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This post discusses the major causes of non-traumatic vision loss focusing on ED diagnosis and management.
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