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...
Independently interpreting plain film imaging is an essential skill for the Emergency Medicine provider. Among the most notorious of injuries likely to be missed is the Maisonneuve fracture. In this post we demonstrate the "can't miss" imaging findings to ensure that you don't make the mistake of thinking this is "just an ankle sprain!"
In this video, Cooper Emergency Medicine Residency graduate and current ultrasound fellow at Hennepin County Mark Robidoux demonstrates a few tips and tricks to quickly become a pro in ultrasound guided angiocath insertion (with a little help from Cooper Assistant to the Program Director and volunteer pincushion Rich Byrne)
Dynamic hyperinflation (autoPEEP, air trapping, etc.) is a process leading to an increase in end-expiratory lung volumes and increased airway pressures. This process may occur secondary to obstructive lung pathology and/or an increase in minute-ventilation without sufficient time for expiration. The pathologic effects of dynamic hyperinflation include an increased work-of-breathing, barotrauma, pneumothorax, and an increase in intrathoracic pressure leading to a decrease in cardiac output and possible hemodynamic collapse. Rapid identification of this process is crucial for reversing it.
It’s another busy shift in the Emergency Department and you are seeing the third patient of the day in atrial fibrillation with rapid ventricular response. You think to yourself, “simple plan and disposition: stabilize, start on a diltiazem infusion, anticoagulate and admit to cardiology, right?” Well before you proceed with this well accepted approach, consider an alternative management strategy where you can even discharge the patient home!
The anatomical location of a posterior myocardial infarction makes it's diagnosis not readily apparent. Intimate knowledge of standard and posterior ECG manifestations of posterior myocardial infarctions is crucial to picking up on this potential fatal pathology. This post aims to provide tips for evaluating patients for posterior myocardial infarction.