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Justin Bright

Pearls and Pitfalls of Salicylate Toxicity in the Emergency Department

5 Comments / clinical cases, FOAMED, In the Literature, practice updates /

Emergency physicians commonly care for poisoned patients. These exposures may be either intentional or unintentional. Salicylates are commonly found in many topical and over the counter preparations, yet salicylate toxicity is often overlooked and underestimated as a potential cause for illness in our patients. Below is a condensed quick-guide of common mistakes that emergency physicians may be making with respect to salicylate overdoses and how to fix them. The goals of care to take away from this article are prevention of intestinal absorption and CNS entry of salicylates, as well as drug elimination.

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Teaching the Modern EM Resident

Leave a Comment / EM MINDSET, FOAMED, In the Literature, perspectives, practice updates /

Current EM residents, as part of the Millennial Generation (born between 1981 and the present), now see this new technology as a way of life, and feel the need to be connected online at all times.5,6 As a result, many EM residents have abandoned the traditional lecture hall and textbooks, and have taken to their electronic devices and the World Wide Web for obtaining information.

In order to continue providing quality education that meets the needs of the modern EM resident, the type and quality of educational resources that we deliver must also change.

So the question becomes: How do we use these new resources to guide the education of our current EM residents both on and off shift?

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Endovascular Stroke Therapy: Is This the New Standard?

2 Comments / FOAMED, In the Literature, practice updates /

Every few years, we come to a crossroads that makes us reexamine our current clinical practice and consider a better intervention. For the past twenty years, patients presenting with acute ischemic stroke have had essentially one option for therapy: intravenous thrombolytics. Since the NINDS-2 trial in 1995 [1], tPA has erupted onto the scene of stroke management and has become the gold standard despite ongoing questions behind the true efficacy of tPA.

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One Physician's Advice to the New Grad

2 Comments / EM MINDSET, FOAMED /

To the Class of 2015 – Congratulations!! You’ve made it. After at least 11 years of post-high school education, you have finally reached that proverbial finish line and are ready to transition from resident to attending. What I would like to share with you is some advice about what life is like on the other side. Now that you have finished residency, it’s safe to say that you know the medicine really well. But, I have come to find that your learning about life as a professional is just beginning.

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The Art of Decision Making: Emergency Medicine Style

1 Comment / EM MINDSET, FOAMED, perspectives /

It’s 3pm on a Monday after a holiday. The department is bustling, and you feel like there are patients crammed into every conceivable space. Alarms are going off on patient monitors. You’re in the midst of discussing a case with a resident when a nurse puts an ECG in front of you to review and sign. Just as you finish reviewing the ECG, you turn back to your resident, only to get a phone call from the radiologist notifying you of an abnormal finding on another patient’s CT scan. After looking through the scan, you help guide your resident through an appropriate plan and disposition of the patient they saw, and decide it’s time to round on a few patients you need to see. As you rise from your chair, your EMS phone goes off, and you get word of a cardiac arrest that will arrive in 5 minutes. It’s just then that you realize you have to pee so bad it hurts. Sounds like a typical emergency department shift for many of us, doesn’t it?

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The Patient Experience: Why Is It Important? Why Do We Hate It So Much? What Can We Do To Improve?

5 Comments / FOAMED, happenings, perspectives /

I HAVE BECOME INFATUATED WITH THE PATIENT CARE EXPERIENCE. I believe the term “patient care experience” is a more inclusive term that describes our technical expertise while also including everything else, such as communication, department ambience, throughput, and the behavior of everyone a patient comes into contact with while in the department.

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The Evaluation of Occult Subarachnoid Hemorrhage: Why Are We Still Doing LPs? Is CTA A Better Alternative?

4 Comments / practice updates /

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? […]

The Evaluation of Occult Subarachnoid Hemorrhage: Why Are We Still Doing LPs? Is CTA A Better Alternative? Read More »

Wrist Injuries: Pearls and Pitfalls

Leave a Comment / Uncategorized /

Wrist pain is a frequent emergency department complaint. Most presentations are due to an acute traumatic injury. Furthermore, overuse or repetitive motion mechanisms cause ED visits for either an acute injury or an exacerbation of chronic pain conditions. For the purposes of this post, the wrist is going to be defined as injuries occurring to the distal radius and ulna, as well as any injury to the carpal bones. In addition, I feel it to be a poor use of this forum to simply list every conceivable form of wrist injury. Instead, I’d like to discuss the following:

  • Pertinent questions you need to ask your patient when evaluating a wrist injury
  • Pain management techniques including hematoma blocks
  • Which fractures have a higher likelihood of developing avascular necrosis
  • What type of splint is indicated for a particular injury

[…]

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Ventilator Management in COPD

4 Comments / practice updates /

Editor’s note: This post was listed in the #FOAMED Review (17th Ed.) from EM Curious. It ALSO appeared in LITFL Review 154’s “Best of #FOAMcc Critical Care” section.

Its 7:01am.  Your shift in your department’s high acuity area is just beginning, and you are waiting to receive sign out.  There hasn’t even been time to get your first sip of coffee.  Just as you are lifting your cup to your lips, the charge nurse grabs you and says, “Doctor, I need you!  This patient isn’t looking so good!” […]

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