20 yo male presents to the ED with left hip pain after MVC PTA. Patient was restrained back seat passenger, no LOC. Patient appears very uncomfortable on stretcher, with left leg propped on rolled blanket. Tenderness at left hip but no obvious deformity. LLE with DP pulses 2+, sensation intact, will wiggles toes.
This post is a a summary of a portion of Dr Byrne's airway talk from last month's ResusEM conference at the Cooper Medical School of Rowan University. New techniques for preoxygenation before intubation can help to prolong time to desaturation and make this potentially dangerous procedure safer than ever!
Intubation has traditionally been performed with patients in the full supine position. Recent data suggests that elevation of the head of the bed may be more effective during preoxygenation before intubation. Check out this summary of a paper from Anesthesia that put this idea to the test!
Anatomic landmarks followed by a "blind" stick is currently the standard practice for performing bedside lumbar punctures, but with increasing use and ease of ultrasound, could we one day see lumbar punctures follow in the footsteps of central line placement?
You evaluate a patient complaining of acute onset of dyspnea with hypotension and hypoxia. You immediately consider the diagnosis of acute massive pulmonary embolism, but despite your best efforts can't get good cardiac windows on bedside ultrasound. Should you administer thrombolytics? Heparin? Send the shocky patient for a CT? Today Dr. Simpkins goes through the steps to perform 2-point compression ultrasound of the lower extremity to evaluate for DVT, an easy and rapid bedside test that may allow for indrect but more rapid diagnosis of acute, massive pulmonary embolism.
Have you ever attemped a trigger point injection to improve your patient's musculoskeletal pain? Did it help? This week for his Critically Appraised Topic, Dr. John Cafaro investigated some of the literature on the effectiveness of trigger point injections for patients suffering from musculoskeletal pain.
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...