Co-Authors: Esteban Davila, Hemil Chauhan This is part 2 of a 2-part series focusing on BRASH. Part 1 can be found here. Patient Presentation A 70-year-old male with a past medical history of diabetes, hypertension, and chronic kidney disease (baseline creatinine 2-3 mg/dL) is brought in by EMS after being Read more… The post BRASH Part 2: A BRASH with Death appeared first on County EM ..read more

Co-Authors: Camilo Galeano Londono, Esteban Davila  This is part 1 of a 2-part series focusing on BRASH Syndrome The little black phone in the Cardiac Care Unit (CCU) room rings. The cardiology fellow is on the other end of the line informing you of a new admission. The patient is Read more… The post BRASH appeared first on County EM ..read more

Authors: Esteban Davila, MD and Ian S. deSouza, MD Background Ketamine has many known cardiovascular properties both on the myocardium and the autonomic nervous system through central sympathetic stimulation and inhibition of catecholamine reuptake. The ketamine-induced hyperadrenergic state causes transient elevations in heart rate and blood pressure.[1] We present a Read more… The post Diagnosis of a Supraventricular Tachydysrhythmia During Ketamine Infusion appeared first on County EM ..read more

Authors: Taylor Douglas; Naomi Rebollo Rodriguez Edited by: Nicole Anthony; Wesley Chan Many patients present to the Emergency Department (ED) with the chief complaint of shortness of breath. There are myriad causes and extensive treatments available. However, what about the patient who has dyspnea because they have a terminal illness Read more… The post Emergency Department Management of Dyspnea in the Dying Patient appeared first on County EM ..read more

Author: Alec Feuerbach  Peer Reviewers: Trevor Cerbini, Nicole Anthony Faculty Reviewer: Scott Kendall   Two years ago, Dr. Trevor Cerbini wrote an excellent post for this blog highlighting the basics – and beauty – of buprenorphine (bupe). He highlighted the staggering mortality of Opioid Use Disorder (OUD), explaining that 5.5% Read more… The post Buprenorphine Update: Bupe is (still) “Butiful” appeared first on County EM ..read more

PART I – Cyanide Poisoning (aka “Doc, it hurts right here” *points to mitochondria*) Authors: Trevor Cerbini, MD; Alec Feuerbach, MD, Peer reviewers: Nic Anthony, MD; Wesley Chan, MD Faculty reviewer: Sage Wiener, MD   From apple seeds to false teeth, Tylenol, and cigarettes, salad bars to kool-aid, cyanide is Read more… The post Cyanide Toxicity and Cyanokit – Part I appeared first on County EM ..read more

“So, what are you going to give me for the pain, doc?” “I don’t want to have to come back because of the pain.” We’ve all heard it before. After having received any myriad of pain strategies to ensure you didn’t undermanage their pain in the emergency room: The patient Read more… The post Pain Management After the Emergency Department appeared first on County EM ..read more

Our toxicology mini-fellowship meeting last week was all about bupe (buprenorphine)! Here is a brief review of the key points of discussion.   Why does this matter? As emergency physicians, we are on the frontline in caring for patients with opioid use disorder (OUD). These patients come to the ED Read more… The post Bupe is Butiful: Buprenorphine for opioid withdrawal in the ED appeared first on County EM ..read more

As some of you may have heard, COVID-19 is a thing. We’ve covered it in-depth, here. Fortunately, there’s a cure. President Trump touted it himself and therefore it must be true. So good – so, so good that this will all be over by Easter. Could this be true? Let’s Read more… The post Hydroxychloroquine for COVID-19: Panacea or Wishful Thinking? appeared first on County EM ..read more

Background 2017 AHA/ACC guidelines for the treatment of hemodynamically stable patients with ventricular tachycardia (VT) include the following recommendations:1 Intravenous procainamide can be useful to terminate VT. (Class IIa) Intravenous amiodarone or sotalol may be considered to terminate VT. (Class IIb) In 2013, deSouza et al conducted a systematic literature Read more… The post The PROCAMIO Study – Procainamide or Amiodarone for Stable Wide QRS Tachycardia appeared first on County EM ..read more