FOAMED

Updates in wound care: Normal saline or tap water? What pressure do you need to use? What volume is needed? Should you irrigate clean wounds?

Is Tamsulosin actually useful for renal stone expulsion? Anand Swaminathan does a deep dive evaluation of the literature. You don’t want to miss this!

Death after discharge from the Emergency Department (ED) is an uncommon but nonetheless highly concerning event. Discharge from the ED, on the other-hand, is a frequent event, with over 80% of ED visits culminating in discharge to home or non-acute care. (1) That number may be increasing with more pressure to find alternatives to inpatient admissions. (1,2) Discharge from the ED is a vulnerable time for patients, and it is a high-stakes time for both patients and providers.

An update on awake intubation with a discussion of the needed supplies, various techniques, complications, and modifications.

Airway management is one of the most challenging and critical skills that the emergency medicine physician must master. This is particularly true in the setting of the trauma patient, where the ABCs of trauma evaluation begin with establishing the patency of the airway and ensuring adequate oxygenation and ventilation before moving through the remainder of the trauma algorithm. It is well known that delays in adequate airway management are one of the most common causes of preventable death in both the prehospital and emergency department setting.

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.

A 64 year-old woman with past medical history of diabetes mellitus type 2 that is well-controlled on insulin, hypertension, and asthma presents with 1 week of shortness of breath and cough productive of blood-tinged sputum. The shortness of breath became suddenly worse about an hour ago as she was walking into your emergency department for evaluation and at that time she had symptoms of pre-syncope. She is denying chest pain, palpitations, diaphoresis, nausea, recent travel, or surgery. The patient takes both a beta-blocker and a calcium channel blocker to control her hypertension. She took all of her medications this morning prior to presentation. The patient has no personal history of cancer and there is no significant family history. She denies the use of tobacco, alcohol, or any other drugs.

A 25 year-old female is suddenly rolled back in a wheelchair into your resuscitation area. As you walk into the room, you see a pale, ashen lady with a diffuse red rash holding an emesis basin between her legs filled with a mixture of sputum and blood. You glance up to the monitor as your nurse places a second peripheral IV, and you see an oxygen saturation of 88%, RR of 28, BP of 105/92, HR of 122, and temperature of 99.1. She continues to cough and is barely able to speak due to increased work of breathing. You immediately call for intubation equipment and medications. The intubation goes well with ketamine and rocuronium, despite blood pooling in the oropharynx. The post intubation chest xray demonstrates diffuse infiltrates.

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?

These three patients presented with syncope as part of their respective histories, despite suffering from different pathologies. Syncope is a transient loss of consciousness with rapid recovery to baseline. Each history is concerning for a vascular etiology. In the ED we are focused on risk stratifying and ruling out life threats. Vascular and cardiac causes of syncope are two different pathways that ED physicians must rule out. This post will cover vascular causes of syncope.