You are working at a tertiary care center and a 55-year-old woman is transferred to you from an outside hospital for severe persistent thrombocytopenia of unknown origin. On arrival, she is mildly confused and tachycardic. The platelet count is 7K and the hemoglobin is 5.8. Peripheral blood smear demonstrates schistocytes consistent with microangiopathic hemolytic anemia. The diagnosis of thrombotic thrombocytopenic purpura (TTP) is suspected. TTP is a hematologic emergency: what are the next steps in management?

Submitted by Courtney Martin, DO

A 40 yo M presents to the ED with R wrist pain. Onset was just before arrival when he was lifting at work, "felt a pop" and had sudden onset of pain. Exam reveals swelling and tenderness of the R wrist. Neurovascular exam is normal.

EM Daily's critical care section has done several excellent posts on tracheostomy management. Here we take a step back and review the basics of tracheostomies.

Submitted by Lynn Manganiello, DO

As the COVID epidemic continues with cases rising, managing patients with hypoxemia will continue to be challenging. This video with Dr. Matt Siuba and myself will discuss a few strategies to manage the patient with refractory hypoxemia. 

Submitted by Haney Mallemat, MD