A 49-year-old woman was intubated for acute hypoxemic respiratory failure secondary to pneumonia, which was complicated by empyema. She failed extubation and ultimately required tracheostomy for prolonged mechanical ventilation. After transfer to the intermediate care unit, she was successfully weaned from the ventilator for over 24 hours. She tolerated prolonged deflation of her tracheostomy cuff and swallowed water without aspiration. She underwent a tracheostomy tube occlusion test and there was no obstruction to air flow with a size 7 fenestrated tracheostomy tube in place. She is requiring suctioning once every 12 hours. You are assessing her readiness for tracheostomy decannulation and are considering the utility of a capping trial.
Read moreSubmitted by Emily Damuth, MD
Dr. Murphy discusses Methemoglobinemia.
Read moreSubmitted by Emily Murphy, MD
With several anticoagulants now on the market, one needs to be well versed in the various reversal options in the setting of lifethreatening bleed (or if supratherapeutic on coumadin). Here's your quick review.
Read moreIt’s a familiar call ahead to the ED - an adult patient who is febrile, hypotensive, with suspicion towards infection. While setting up the room, the patient’s bedside nursing team asks if you’d like them to get saline or lactated Ringer’s (LR) ready for resuscitation. You wonder if there’s any new evidence examining the use of saline versus balanced crystalloids in the emergency department.
Read moreSubmitted by Lars-Kristofer Peterson, MD
Dr. Murphy discussed cyanide toxicity
Read moreSubmitted by Emily Murphy, MD
A 17 yo F with no PMHx presents to Urgent Care w/ L sided chest pain. Pain sharp, radiates to L upper back, has been intermittent x 1 month, worse x last 2-3 days. No exacerbating or relieving factors. She denies fever/chills, cough/URI sx, LE pain/edema. No prior hx of DVT, no OCPs.
Read moreSubmitted by Sydney Tabaac, MD
An 87 yo male is brought in by EMS after a syncopal event while on the toilet, resulting in a fall and head injury. EMS reports a heart rate in the 30s en route. As your approach the resuscitation bay you begin to think about the causes of bradycardia and what your approach will be to stabilize this potentially very sick patient....
Read moreSubmitted by Richard Byrne, MD
Hypoglycemia can be a lifethreatening emergency - here's your quick review of s/sx, causes and management.
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