Adrenal Crisis Review

Adrenal Crisis, by Dr Nilesh Patel -Also known as acute adrenal insufficiency or Addisonian crisis -No universally accepted definition. Proposed Definition: Acute deterioration in health status associated with hypotension (SBP < 100) or relative hypotension (drop in 20 mmHg from baseline) that resolve in 1-2 hours after glucocorticoid therapy. Generally this occurs in patients with …

Trauma Month!

We love us some trauma here at Joes! Check out our favorite sources of FOMED that supplemented our Tintinalli readings!   Trauma 1 Cant Miss Readings: RebelEM: Ten Commandments of Trauma Resuscitation http://rebelem.com/ten-trauma-resuscitation-commandments/ RebelEM: Spinal Immobilization in Trauma Patients http://rebelem.com/spinal-immobilization-in-trauma-patients/ PEMPlaybook: Multisystem Trauma in Children Part 1: Airway, Chest Tubes, Thoracotomy http://pemplaybook.org/podcast/multisystem-trauma-in-children-part-one-airway-chest-tubes-and-resuscitative-thoracotomy/ Part 2: Massive …

Nitrous Oxide in the Pre-hospital setting

Nitrous Oxide in the Pre-hospital Setting Nitrous Oxide in the Pre-hospital Setting By: Gregory Cassidy M.D., PGY3 Nitrous oxide is a colorless, tasteless gas that is administered in combination with oxygen, often referred to as “laughing gas”.  It is absorbed via the pulmonary vasculature following inhalation through a facemask.  The patient may self-administer the gas …

Resiliency

Resiliency is the human character trait to suffer an insult and return to a state of dis-despair, to return to one’s homeostatic equilibrium. In life we all will encounter problems, errors, disasters. How we deal with it, is how we come to be resilient. As physicians, we must take our own advice and practice what …

Pediatric Pearl – Anaphylaxis

ANAPHYLAXIS By: Hima Khamar, PGY3 4-year-old female presents to ED with parents due to 1 week of cough, fever, congestion, irritability, and decreased PO intake. CXR shows RLL pneumonia, patient is started on Ceftriaxone. 5 mins after the initiation of Ceftriaxone infusion, patient begins to complain of itchy scalp, starts coughing uncontrollably (much worse than …

Pediatric Pearl: UTI (February)

FEBRUARY UTI – Hima Khamar Pediatric Urinary Tract Infection By: Hima Khamar, PGY3 In a previous pediatric pearl, we discussed how to treat febrile infants below 60 days. This pearl discussed management of pediatric urinary tract infection (UTI), but also discusses patients above the age of 60 days with a fever with no obvious source …

COW

Presenting Resident: Katrina D’Amore, PGY4 Chief  Complaint: Palpitations Brief HPI: 36 y/o F G4P2012 at 18 weeks gestation presents complaining of palpitations that began this morning. Patient reports a history of “SVT” multiple times in the past and she even underwent ablation in 2012.  Patient states that “Adenosine never ever works for me.” Patient  denies …

TRANEXAMIC ACID (TXA)

TRANEXAMIC ACID (TXA) By: Hima Khamar M.D., PGY3 Tranexamic acid (TXA) has become a huge asset in the world of emergency medicine when it comes to controlling hemorrhage. The main use in the ED is in traumatic hemorrhage, but there are many other uses for TXA. In this article, I will discuss some of the …

Pediatric Pearl

Pediatric Pearl – January PAIN MANAGEMENT & VASO-OCCLUSIVE CRISIS IN SICKLE CELL DISEASE By: Hima Khamar, PGY3  &  Dr. Patel, PGY16 Sickle cell disease (SCD) is a common disease process we encounter in the ED. There are multiple complaints related to SCD that patients present with such as: pain, fever, stroke like symptoms, anemia. In this …

Physician burnout

As physicians, we all decided to help others. Those of us in Emergency Medicine decided to help others at their most ill, at the most traumatic moment in their lives, or at their wits end as far as where to seek answers. Sometimes we can help, and sometimes we cannot. Regardless of what their reason …