practice updates

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.

The crashing neonate: What could possibly go wrong? An updated review with pearls and pitfalls in the presentation, diagnosis, and management of inborn errors of metabolism

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.

An update on the medical clearance of patients presenting to the ED with primary psychiatric complaints. What tests are actually helpful?

Rapid Sequence Intubation (RSI) is one of the most critically important skills for an Emergency Medicine physician to be able to perform quickly and accurately. All airway management in the emergency department is performed on the unstable patient, often with unknown co-morbidities and a full stomach. In recent years, standard medication choices for induction were etomidate and succinylcholine. While other medications were proposed and tried, several were avoided for hypothetical side effects that have not borne out in recent research. Arguably, the modern combination of ketamine and rocuronium has less significant complications, and provides a superior alternative to etomidate and succinylcholine.

An update on the cause, pathophysiology, diagnosis, and management of Lemierre’s syndrome