Cardiac Glycoside containing plants : Foxglove, Lilly of the Valley, Oleander, Squill Contain cardiac glycosides, which act as a negative chronotrope as well as a positive inotrope. Patients present with nausea, vomiting, visual changes, bradycardia/arrhythmia, and may develop hyperkalemia – a poor prognostic factor Treatment is Digibind/DigiFAB – look out for the side effects of […]

You are working at Clerkship General when you see your next patient : a 3 year old male accompanied by his father with chief complaint of vomiting.  Initial Vitals Temp 98.6 HR 50 RR 20 BP 95/55 O2 100% Critical Actions Identify the history of ingestion Check a blood glucose Call Poison Control Treat with […]

Opioid overdose is the number one leading cause of death in adults under the age of 50. Many ED Physicians fail to recognize that offering MAT (medication assisted therapy) to victims of opiate overdose is one of the most effective interventions we can offer in medicine. 1 in 2 using high-dose buprenorphine (≥ 16 mg) […]

Critical Actions: Administer Naloxone Minimize Unnecessary Testing Discuss options for Rehab Offer opioid replacement therapy Provide Social Support Further Reading: Buprenorphine – EMDocs Naloxone – EMDocs Initiating Opioid Treatment in the ED – ACEP

AFib with Rapid Ventricular Rate (RVR) – Rate >110 Primary AFib – Patients symptoms or their hemodynamic instability is due to the AFib itself. Treatment is by rate or rhythm control. Secondary AFib – Patients AFib rate or their hemodynamic instability is due to an underlying secondary process (eg thyrotoxicosis, PE, sepsis, drugs, etc). Treatment […]

You are working a shift at Clerkship General Hospital when you go see your next patient, a 70 year old male presenting with chest pain. Initial Vitals Temp 98.7 HR 140 RR 20 BP 125/85 O2 99% Critical Actions Obtain EKG Treat AFib RVR via rate control (and not cardioversion) Diagnose Acute Arterial Occlusion Treat […]

tPA usage is controversial. Listen to find out why. Read more to form your own opinions. Episode Sources: After Re-Analysis, No Trials Show Efficacy of tPA in Acute Ischemic Stroke Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department Why we can’t trust clinical guidelines […]

Initial Assessment: Obtain Vitals and blood glucose level Time of onset (important for tPA/TNK vs thrombectomy) Neurologic and Cardiac Examination / NIHSS do not delay head CT to complete NIHSS, can always finish after CT Assess contraindications for tPA Workup: Labs: CBC, CMP, Troponin, Coags, EtOH, bedside accucheck CXR and UA (infections can cause recrudescence […]

ATLS – Advanced Traumatic Life Support Primary Survey Airway Breathing Circulation Disability Exposure Secondary Survey Head to Toe Examination Look for injury patterns and important injuries, such as Battle Sign (post auricular ecchymosis) Raccoon Eyes (infraorbital ecchymosis) Hemotympanum Nasal Septal Hematoma Urethral Injuries Circumferential Burns Obtain a basic medical history Obtain XRs, FAST exam, CT […]

You are working a shift at ABEM General when you receive a call from EMS over the radio for a patient involved in a house fire. Initial Vitals Temp 99.0 HR 150 RR 40 BP 90/50 O2 95% Critical Actions Administer 8L IVF in first 8 hours Administer supplemental oxygen for CO poisoning Administer TDAP […]