Ectopic pregnancy is a common and potentially fatal emergency in early pregnancy. Its prevalence is about 2% in the general population, but is as high as 16% in women presenting to the emergency department with concerning symptoms. Ectopic pregnancy is a cause of pregnancy-related death and can also lead to chronic pelvic pain, need for blood transfusions, and long-term infertility. Because of the potentially devastating outcomes, it is imperative that emergency physicians diagnose ectopic pregnancy early and refer patients to the proper specialist care. [...]

As Emergency Physicians, we are always looking for ways to improve the care we provide to our patients. Based on clinical data which have come to light over the past several years, tranexamic acid (TXA) displays considerable promise toward reducing mortality in hemorrhagic trauma. It’s widely available, cost-effective, and an easy way to save lives. Let’s take a look at the evidence and discuss the potential benefit of TXA use in trauma. [...]

It’s 4pm on a Wednesday. As per usual, the chart rack is full, and you’re trying to stay positive and keep up morale of the entire team. You pick up your next chart, and as you read the chief complaint, your heart sinks into your belly. The complaint is, “severe headache,” and you’re already trying to figure out how you’re going to fit an LP into your busy patient load. Headaches are experienced in all types of ways by our patients. Many are benign – but we are in the catastrophe business. How do we know if the headache is actually a brain mass? Or what if it’s a raging intracranial hemorrhage? And if it is a brain bleed, what kind will it be? If we have a suspicion of subarachnoid hemorrhage (SAH), did our mouse click for “head CT (non-contrast)” just commit us and our patient to a lumbar puncture? [...]

Whether we are working with a medical student, an off-service resident, or even one of our own, most of us involved in the education of emergency medicine have described the mindset of emergency medicine as different from most other specialties. But are we really unique in our approach to patient care and how we think? And if so, can one develop this “EM Mindset?” [...]

What if there was a way to better visualize the heart during cardiac arrest? What if you could see something on the ultrasound screen that triggered a specific, critical, and time-sensitive intervention? According to the 2008 ACEP Ultrasound Guidelines, as well as Matt and Mike from the Ultrasound podcast, that emerging emergency ultrasound application is…

Pediatric cardiogenic shock is an often insidious phenomenon with presentations requiring a broad differential diagnosis. Even after narrowing the diagnosis to cardiogenic shock, the list of possible etiologies is vast and the cause important to determine because the source of the shock will respond differently to different treatments.

I recently had the pleasure of engaging in a point-counterpoint discussion on the optimal agent for Rapid Sequence Intubation with Billy Mallon at Essentials of Emergency Medicine 2014. I took the pro-rocuronium side. For decades, succinylcholine (suxamethonium) was the paralytic agent of choice (and the only available option) for RSI. The National Emergency Airway Registry (NEAR) found that it was used in 90% of airways. Succinylcholine has a number of perceived advantages that led to this situation:

• Rapid onset (45-60 seconds)
• Short half-life (6-8 minutes of paralysis)

Rapidly achieving an optimal intubating environment is critical as prolonged time to paralysis can delay successful intubation, potentially leading to oxygen desaturation. Early data demonstrated that succinylcholine reached optimal intubating parameters more rapidly than rocuronium (Sluga 2005, McCourt 1998, Laurin 2000). However, this difference was shown to be caused by inappropriate dosing of rocuronium (0.6 mg/kg in most studies). When a 1.2 mg/kg dose of rocuronium is given, the time to achieving optimal intubating parameters is virtually equivalent (Herbstritt 2012). Rapid offset has been touted as an advantage because if the airway provider was unable to intubate the patient, the drug would wear off quickly and the patient would resume spontaneous breathing before desaturation occurs. We will see later why this logic is flawed. Over the last 4-5 years, the RSI agent preference has swung away from succinylcholine. There are likely numerous reasons for this swing including drug shortages but a better understanding of the limitations of succinylcholine are also likely at play. [...]

A particularly complicated case and tricky diagnosis, along with the need-to-know information for all emergency physicians