recent articles

practice updates

Lipid Emulsion Therapy

"The lack of high-quality controlled human studies precludes ILE as a first-line agent for indications other than local anesthetic systemic toxicity"
Thanks to James Cao, MD for this excellent review of the literature on the use of ILE therapy in various toxicologic emergencies.

clinical cases

Mystery Bleed (M&M)

We're grateful to Mathew Miskimon, MD PhD for providing this morbidity and mortality (and improvement!) case from Janus General. Includes a nice discussion at the end on the systemic factors contributing to the outcome.

practice updates

Airway Subtleties in Critically Ill Patients

DKA: "Trying to intubate [...] using standard approaches can cause a period of apnea, which can kill your patient"
Cynthia Santos, MD with recs for your patients with salicylate toxicity, sepsis-induced ARDS, and DKA (ie, the ones who will likely require some modification to your usual airway algorithm). Crucial info here!

clinical cases

"Rule out SBO"

A diagnostic dilemma from the case files of Janus General. The presentation of this clinical zebra is provided by one of our esteemed editors, Adaira Landry, MD (@AllAroundDoc).

practice updates

Massive Vaginal Bleeding

"Packing may be the most effective hemostatic temporizing measure that can be performed in the ED"
Jessica Lopez, MD discusses the management of the non-pregnant patient with severe vaginal bleeding, including tamponade techniques and the utility of tranexamic acid.

ultrasound

Shoulder Ultrasound: Intra-Articular Injection and Reduction

"One systematic review found intra-articular injections to be as safe and effective as procedural sedation for bedside shoulder reductions"
Last month Tyler Dschaak, MD told us about using ultrasound to diagnose a septic hip. Today's post is on the utility of ultrasound in the diagnosis and management of shoulder dislocations.

Peds EM Morsels

Options to Intravenous Fluids

IO Placement: "Should be done without hesitation in a child who lacks easily obtainable IV access and signs of poor perfusion"
Placing an IV in a sick pediatric patient can be a real challenge. Fortunately, there are options! Thanks to Sean M. Fox, MD (@PedEMMorsels) for this gem with significant clinical relevance.