"Some will not have a palpable pulse, and unfortunately, manual BP cannot be obtained. In addition, pulse oximetry is unreliable"No pulse? No problem! Manpreet Singh, MD covers a stepwise approach to troubleshooting ventricular assist device complications in the emergency department.

"Balance between bleeding and thrombosis"Novel medications like dabigatran and rivaroxaban are increasingly being used to treat patients requiring anticoagulation, but management of bleeding can be a real challenge. Jake Rabe, MD discusses recent trials and reversal strategies.

"The clinical picture is a mix of ARDS and air embolism"Zara Mathews, MD covers the subject of blast injuries, including a review of the basics, important updates in the workup of these patients (for example, tympanic membrane rupture is not a great predictor of injury), and common pitfalls in management.

"Psychosis that can last for days to weeks"Unless your patient on bath salts is very forthcoming, you may be on your own when making this clinical diagnosis. Be prepared with this primer on cathinones by Kyle Brown, MD.

A practice update on adult epiglottitis in the ED.