Resus of the hypotensive patient Part 1 - When IV Fluids Kill

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Resus of the hypotensive patient Part 1 - When IV Fluids Kill

There is probably no other drug emergency providers administer more often than IV fluids.  We give them to patients with mild heat exhaustion, gastroenteritis and orthostatic dizziness to name a few.  These patients tend to feel better, go home and no harm comes to them.  However, for the subset of patients with shock and potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.    

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What the Heck is Going on with this Pacemaker?!

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What the Heck is Going on with this Pacemaker?!

Pacemakers and implantable cardioverter/defibrillators (ICDs) are fascinating little machines.  They were first placed in survivors of sudden cardiac death in 1980, and over the past several decades have become more complex with increasing abilities to sense, pace and defibrillate.  As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and ICDs will present more commonly to the emergency department.  It is imperative that the emergency provider have a framework for troubleshooting these devices.  This post will briefly review the use of the "donut" with an implantable pacemaker, as well as three pacemaker malfunctions the emergency provider may encounter.

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Feature Film - Myths and Misconceptions about Testicular Torsion

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Feature Film - Myths and Misconceptions about Testicular Torsion

Testicular torsion is present in approximately 3 – 17% of children brought to the ED with scrotal pain.  It has a bimodal incidence in the first year of life and at puberty, when the rapid increase in testicular volume predisposes the testis to torsion. While not as common, it can also occur late into adult hood. Because the testicular salvage rate is time dependent, prompt recognition and diagnosis is an essential skill of the emergency provider.  In this month's feature film, Dr. Jacob Avila busts some myths and misconceptions about testicular torsion. 

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Journal Club October 2017 - Treatment of Acute Low Back Pain

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Journal Club October 2017 - Treatment of Acute Low Back Pain

Low back pain is one of the most common emergency department presentations. Though diagnosis is often straightforward, pain management can be a source of frustration for both the patient and the provider, especially as we focus on limiting narcotic prescriptions given the spreading opiate crisis. In an effort to manage pain, practitioners often counsel patients on the use of over the counter medications or discharge them with a prescription, but what is the evidence behind these medications that we commonly use for back pain? For this month’s journal club, we reviewed three articles that studied the use of acetaminophen, NSAIDS plus muscle relaxers or opiates, and corticosteroids for the management of acute low back pain.

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Journal Club September 2017 - Angioedema

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Journal Club September 2017 - Angioedema

Angioedema (non-pitting edema of submucosal tissues) results in infrequent, but high-risk emergency department visits. Since airway edema can make oropharyngeal and nasopharyngeal intubation impossible, our focus is on early and aggressive pharmacologic treatment to prevent life threatening airway obstruction. Recall that angioedema can come from two broad physiologic mechanisms: histamine mediated (ie allergic in nature which may have urticaria or other evidence of anaphylaxis) or bradykinin mediated (eg hereditary angioedema, ACE-induced angioedema). Histaminergic mediated typically responds well to aggressive antihistamines, steroids, and epinephrine. Bradykinin mediated, however, does not.  This month we focused on this type of angioedema that can be non-responsive to our typical first line therapies. 

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Feature Film: D-dimer, Wells, PERC... Pitfalls of Pulmonary Embolism Diagnosis

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Feature Film: D-dimer, Wells, PERC... Pitfalls of Pulmonary Embolism Diagnosis

Dr. Ali Raja is the co-author for American College of Emergency Physicians and the American College of Physicians guidelines committee for pulmonary embolism.  He was also voted the most outstanding speaker for our 2017 Maine Medical Center Winter Symposium.  We chose to highlight his lecture - "D-dimer, Wells, PERC rule - Pearls and Pitfalls of Pulmonary Embolism Diagnosis" as our next feature film.  In this lecture, Dr. Raja shares some pearls and pitfalls on the various tools at our fingertips for the diagnosis of pulmonary embolism. 

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Lungs are Sometimes Better Seen than Heard

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Lungs are Sometimes Better Seen than Heard

An old mentor of mine liked to say "sometimes lungs are better seen than heard."  While he was referring then to good old fashioned chest xray, current literature clearly supports the use of bedside ultrasound as a valuable tool in evaulating the dyspneic patient.  In this lecture, Dr. Jacob Avila discusses the use of the bedside ultrasound in detecting pneumonia, pulmonary embolism, congestive heart failure, and pneumothorax. 

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What do you want to be when you grow up?

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What do you want to be when you grow up?

Wondering which fork in the road to take after your emergency medicine residency? Interested in academics, but would also love to find that sweet job with surf just down the street?  We were fortunate to have a parade of stars for our 2017 emergency medicine career day.  Take a look to find help on buffing your CV, finding your fellowship, evaluating an academic career, or critiquing a contract for a private group. 

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