Critical Cases - New Onset Afib with High Output Heart Failure!


  • 49 yo F  pHx asthma presents  ED with worsening DOE for the last month acutely worsening today 
  • No prior hospitalizations or intubations for asthma exacerbation 


  • Positive for dyspnea, palpitation
  • Positive for abdominal distention, which she attributes to constipation


  • Moderate intermittent asthma on albuterol PRN 

Physical Exam

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Critical Procedures: How to Create a Pericardiocentesis Model

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:

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Critical Cases - BRASH Syndrome & Cardiac Arrest!

A 69 year old man is brought in by EMS with complaints of chest pain. ALS noted pt to be in sinus bradycardia in the 30s en route. As you approach the room you wrack your brain: what are the common causes of bradycardia? More importantly - will I get to actually perform a transvenous pacemaker i.e. the most highly sought after procedure as an emergency medicine resident?

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Critical Cases - Bradycardia Emergency!

An 87 yo male is brought in by EMS after a syncopal event while on the toilet, resulting in a fall and head injury. EMS reports a heart rate in the 30s en route. As your approach the resuscitation bay you begin to think about the causes of bradycardia and what your approach will be to stabilize this potentially very sick patient....

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