Delivering a baby in the emergency department is far from ideal and although all usually goes well, you need to be prepared in case it doesn’t. Shoulder dystocia gets a lot of hype because of those fancy corkscrew maneuvers, so instead of that we’re going to talk about another dreaded complication, post-partum hemorrhage.
Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818
Think just because you are a young, healthy physician that you are invinceable? Read this post and remember that we are vulnerable too...even more so because we often refuse to acknowledge when we are sick. This week's Advanced Practice topic comes to us courtesy of a Cooper EM alum. The story is told with full permission from the patient, his wife, though names are omitted to prevent any possible HIPPA entanglements!
Do you routinely perform large volume (or near large volume) paracentesis in your ED? If so, you need to know about a potentially life-threatening complication of this procedure...
A 34 year old Vietnamese male presents with complaint of neck swelling. It began one month ago and worsened over the past few days. He endorses fatigue and a mild weight loss. Exam shows an indurated, non mobile mass without tenderness or erythema. You order imaging and are concerned for TB but unsure what to do next.
So you think your young, healthy, sexually active patient with a painful joint and weird skin findings might have disseminated gonococcal infection or gonococcal arthritis…but you’re not sure of the difference between the two. Is there a difference? Then you wonder how to properly diagnosis and treat such an illness.
Tranexamic Acid! It seems everywhere we look there are people touting TXA as the next miracle drug. This post introduces the clinical applications of TXA and the evidence supporting its use.
A 34 yo female with a history of trigeminal neuralgia presented to the Emergency Department with a chief complaint of 5 days of severe, worsening paroxysms of pain in the left trigeminal nerve distribution. The pain was refractory to carbamazepine and gabapentin. Neurology was consulted and an unconventional therapy was recommended.
You are intubating a sick patient in the ED via direct laryngoscopy. After opening the airway, sweeping the tongue with your blade, inserting into the vallecula, and lifting at the precisely correct angle your eyes behold....well...not the vocal cords! Maybe the arytenoid cartilages if you're lucky (aka Cormack Lehane 3 or 4 view). But wait, you aren't finished yet! You reach into your back pocket and remove your trusty bougie...