During Week 12 of this NFL season, Washington Redskins tight end Jordan Reed injured his shoulder while attempting to catch a pass in the endzone against the Dallas Cowboys. While Reed continued to finish the first half, he was diagnosed with an AC joint separation at halftime. This posts will give an review of the evaluation and management of AC joint separations in the ED.
Joseph Cesarine, MD
The differentiation between peripheral vertigo and central vertigo can be exceedingly difficult as symptoms of both clinical entities largely overlap. This diagnostic dilemma can be particularly painful for Emergency Medicine physicians and their patients as the workup for central vertigo rules out "can't miss" pathology with imaging that typically takes hours to obtain.
In the setting of a severe asthma exacerbation that is refractory to medical mangagment and noninvasive ventilation, mechanical ventilation can be life-saving. However, the ventilator can quickly kill your patient if careful thought is not taken to address the unique respiratory needs and pulmonary physiology inherent to severe asthma.
The mild, moderate, or severe asthma exacerbation is cemented in the practice of Emergency Medicine. As a provider of this great speciality, one should be intimately familiar with the range of therapies employed. The goal of this post is to provide a high-yield review of the therapies we use (or sometimes use) while treating these patients.
A high-yield review of the past week on EMDaily.
In the era of Press Ganey, patient-oriented outcomes, hospital reimbursement, and physician compensation are all tied to patient satisfaction. Improving patient satisfaction is now a multi-billion dollar industry and encroaches on every aspect of healthcare, including residency training. How do doctors at the beginning of their careers affect patient satisfaction and impact Press Ganey Scores? This post reviews two studies shedding light on this issue.
When treating acute, wide-complex tachycardia deemed to be stable, monomorphic ventricular tachycardia, two agents remain prevalent among emergency medicine physicians: amiodarone and procainamide. This post examines some of the evidence behind these agents in achieving successful conversion of stable, monomoprhic VT.
High-yield review of recent literature in Emergency Medicine: Kupas F et al. "Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similiarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients." Annals of Emergency Medicine. December 2016.
Case: A 68 year old woman presents to the ED with fever, hypotension, and AMS. She has a PICC in place. Your overzealous intern places a central line, and he swears the stick was venous. You obtain and CXR to confirm line placement. Where does the line terminate?
Answer: B. It is venous but extends to the right brachiocephalic vein. The central line is inadvertantly deep and likely resulted from the guidewire being displaced by the patient's PICC line. This patient will need the line removed/replaced.
Estimated Central Line Lengths for Correct Placement:
Right Internal Jugular Vein: 13 cm, +/- 2 cm
Right Subclavian Vein: 15 cm, +/- 2 cm
Left Internal Jugular Vein: 15 cm, +/- 2 cm
Left Subclavian Vein: 17 cm, +/- 2 cm