This is a first draft (2024-12-26). If there's anything you'd change, add or delete, I can add. This is based on things I've read & conversations with people in our department. Happy to add more. Efficiency in the Emergency Department is about maximizing impact by preserving your energy, managing limited resources, and streamlining workflows—so you … Continue reading ED Efficiency →

This patient presented with palpitations. Their blood pressure was good and they were alert and talking. They had a strong preference not to be shocked. What is this EKG and what drug would you use to treat it. Hint: the QTc = 580 ms. There is no old EKG. Answer The EKG shows a monomorphic, … Continue reading EKG 2024-08 →

Hospitals create a hazardous materials plan laid out with details on possible sources of contamination, hospital evacuation, taking into account specific hospital characteristics and treatment strategies. https://www.youtube.com/watch?v=M70MRuK6-t4 Decontamination in the ambulance bay at Rush Medical Center, Dr. Rumoro 2012 Decontamination of patients should serve two goals: Protect caregivers from the offending agent. Should a caregiver become affected, this … Continue reading Principles of Chemical Decontamination →

a brief history of clot busting The EM community had always been wary about the thrombolytics literature. Ken Milne (Canadian EM doc) posts a summary on ACEPNOW in September 2020. There is a long history of studies on clot busting. yearevents1950sstreptokinase (from streptococcus) and urokinase (from human urine) used, but led to a lot of … Continue reading Stroke 04: Arc of the Literature →

There are many types of brain imaging we can get in patients presenting with stroke. CT head without contrast CT angiogram of head and neck Multiphase CT CT perfusion MRI with diffusion-weighted imaging Fluid attenuated inversion recovery (FLAIR) - T2 weighted sequences Susceptibility weighted MR MR angiograms Perfusion weighted imaging It's good to know what … Continue reading Stroke 03: imaging →

Stroke care begins with prevention by addressing modifiable risk factors such as inactivity, HLD, diet, HTN, obesity, DM, cigarette smoking, cardiac disease, carotid stenosis and managing sickle cell. Non-modifiable risk factors include older age, male, race, family history, genetics and low birth weight. Much of this will hopefully occur with the patient's primary care physician … Continue reading Stroke 02: Workup →

Case 1: Patient: John D., 45-year-old male History: John has been consuming 8-10 beers daily for the past 15 years. He decided to quit drinking two days ago due to family pressure. He has a history of AWS but no previous severe withdrawal episodes. Physical Exam: The patient presents with moderate tremors, slight tongue fasciculations, mild psychomotor agitation, … Continue reading Managing Alcohol Withdrawal in the ED →

Understanding "Human Error" Humans make mistakes. Any system that depends on perfect performance by humans is doomed to fail. The risk of an accident is more a function of the complexity of the system than it is the people involved. Humans are not the weak link in a process. We are a source of resilience. … Continue reading MM&I Theory →