Authors: Jacob Tauferner, MD (EM Resident Physician, UTSW/ Dallas, TX); Mihir Patel, MD (EM Attending Physician, Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics. We’ll keep it short, while you keep that EM brain sharp. A 24-year-old male presents to the ED from a mixed marital arts ..read more

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. Cambron, DO (EM Attending Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX)// Reviewed by: Anthony Spadaro, MD (@TSpadaro91, Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit)     Case: You are in the middl ..read more

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed, a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM, and sign up for email updates here. #1: Phoenix Criteria – New Pediatric Sepsis Score Spoon Feed The Phoenix Sepsis Score, which is a novel clinical criterion for pediatric sepsis and septic shock developed using measures of organ dysfunction, outperforms existing IPSCC criteria for the diagnosis of pediatric sepsis and septic shock. Source Development an ..read more

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! This series provides evidence-based updates to previous posts so you can stay current with what you need to know. An 18-year-old female presents to the ED for abdominal pain. The pain began the day prior in the “middle of her stomach,” but is now “lower to the right ..read more

Today on the emDOCs cast Brit Long interviews Zachary Aust on the use of a mental model in post ROSC patients. Episode 98: Post ROSC Mental Model What’s the problem? The Code Whatever caused the initial arrest Iatrogenic injuries from CPR  Patients are in a pathophysiologic state that is being called “post-cardiac arrest syndrome” Hypoxic brain injury Myocardial dysfunction Systemic ischemia/reperfusion injury SIRS Response Very fragile state Hard to diagnose what is going on Small Things Matter   Overview – C A B S Circulation Close monitoring of perfusion Arterial L ..read more

Authors: Luke Bailey (Medical Student, Texas A&M SOM, Bryan, TX) and Scott Wieters, MD (Associate Dean Temple Campus, Texas A&M SOM, Temple, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics. We’ll keep it short, while you keep that EM brain sharp. A 70-year-old female with a past medical ..read more

Authors: Zachary Boivin, MD (@ZachBoivinMD, Ultrasound Fellow, Yale University); Jia Jian Li, MD (@JjMDUS, Ultrasound Fellow, Yale University) // Reviewed by: Stephen Alerhand, MD; Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction Anytime a patient presents to the ED with abdominal pain, biliary pathology should be considered in the diagnosis.1 A biliary point-of-care ultrasound (POCUS) is the fastest and most accurate way to assess for biliary pathology, but it can be difficult to locate the gallbladder, as it is not a fixed organ.2, 3 Biliary POCUS can help decrease patie ..read more

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed, a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM, and sign up for email updates here. #1: Ketamine for the Win? Induction Agents Compared Spoon Feed A Bayesian meta-analysis found an 83.2% probability that ketamine lowers mortality compared to etomidate in critically ill patients undergoing intubation. Source Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults ..read more

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives. If you have a story to share click here. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights Speaking in “Code” Discussing resuscitation options with patients nearing end of life   “A kinder, gentler approa ..read more

Today on the emDOCs cast with Jess Pelletier and Brit Long, we discuss the challenging diagnosis of spontaneous cervical artery dissection (sCAD). Episode 97: Spontaneous Cervical Artery Dissection   Definition/pathophysiology: sCAD refers to a tear or separation of arterial wall layers involving either the carotid or vertebral arteries. Creates a false lumen where blood may enter the vessel wall between the intima and the media or between the media and the adventitia. An intramural hematoma and subintimal dissection can cause luminal stenosis and occlusion. Thromboembolism can lead to ..read more