Written by: Chezlyn Patton, MD (NUEM ‘27) Edited by: Keara Kilbane, MD (NUEM ‘25) Expert Commentary by: Matt McCauley, MD (NUEM ‘21) Introduction Tracheostomy is a common procedure in the US with over 110,000 trachs placed annually (1). Complications occur at a rate of approximately 40-50%, however most complications are minor, with only 1% being catastrophic (1). Of these devastating complications, 90% occur within the first 10 days of placement. Overall approximately 15% of tracheostomies will be decannulated accidentally, and in a critical care setting, 50% of airway related deaths were as ..read more

Written by: Jilan Shimberg, MD (NUEM ‘26) Edited by: Rafael Lima, MD (NUEM ‘23) Expert Commentary by: Matthew R Levine, MD Expert Commentary Unlike many of the treatments and interventions we use in the Emergency Department and the trauma bay, tranexamic acid (TXA) has rather robust studies to guide usage. Like many interventions, however, even when there are studies with large numbers of patients and positive results, there are still barriers towards implementation. TXA is no different. Working at a Level 1 Trauma Center and frequently interacting closely with the trauma surgeons through the ..read more

Written by: Courtney Premer-Barragan, MD, PhD (NUEM ‘25) Edited by: Adam Payne, MD (NUEM ‘24) Expert Commentary by: Kelsea Caruso, PharmD Expert Commentary “Pump and dump” is definitely the easy way out for the emergency medicine provider, but this practice can have detrimental effects on the baby and on the mother. There is a false pretense that many medications are harmful to the breastfeeding infant, but this is not the case. The other consideration to have when thinking about medication use in breastfeeding is the medication effects on the mother’s lactation and the medication impact on b ..read more

Written by: Courtney Premer-Barragan, MD, PhD (NUEM ‘25) Edited by: Adam Payne, MD (NUEM ‘24) Expert Commentary by: Kelsea Caruso, PharmD Expert Commentary Emergency Medicine practitioners may be quick to recommend patients to “pump and dump” when on antibiotics, but this can have downstream detrimental effects on the baby and on the mother. With the numerous indications for antibiotics, including some dealing with breastfeeding itself, it is imperative that EM providers recognize that most antibiotics are considered safe. Most beta-lactam antibiotics are considered safe in breastfeeding wome ..read more

Written by: Evelyn Huang, MD (NUEM ‘24) Edited by: Julian Richardson (NUEM ‘21) Expert Commentary by: Tyler Black, MD, FRCPC COVID-19 has been difficult for everyone. Deaths, isolation, loss of work, and countless other hardships abound. With this, comes the concern for mental health crises. In a survey from June 2020, 11% of adults reported thoughts of suicide in the past 30 days [1]. It can be hypothesized that the pandemic has increased suicide rates. However, does this bear out in the literature? As frontline workers, and oftentimes the only interaction that patients have with the healthc ..read more

Written by: Mike Tandlich, MD (NUEM ‘24) Edited by: David Feiger, MD (NUEM ‘22) Expert Commentary by: Michael Schmidt, MD Expert Commentary While EMTALA was first enacted to address issues with “patient dumping”, it has had broad influence on how patients are treated, dispositioned, and transferred in emergency department and hospital settings. In addition, EMTALA law has taken on almost mythic proportions among healthcare workers and administrators, likely due to high-profile cases, the fear of potential violation of the law and subsequent penalties, the potential for it to bolster civil mal ..read more

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by: John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. It is not surprising that unpredictable work hours mixed with frequent interactions with patients undergoing physical and emotional trauma can cause spillover into the personal lives of ED staff. However, in the recent years there has been an increasing body of literature that highlights the challenges that we face as ED personnel.  The American Hear ..read more

Written by: August Grace, MD (NUEM ‘24) Edited by: Andrew Rogers, MD, MBA (NUEM ‘22) Expert Commentary by: Andra Farcas, MD (NUEM ‘21) Introduction In the setting of trauma, most hospitals are adept at treating and managing patients with a variety of injuries. However, the ability of a hospital to handle a mass casualty incident (MCI) requires a completely different approach and, most importantly, adequate triage and pre-planning. An MCI is defined as “an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a ..read more

Written by: Kishan Ughreja , MD (NUEM ‘23) Edited by: Ade Akhentuamhen, MD (NUEM ‘21) Expert Commentary by: Tim Loftus, MD, MBA Journal Club: Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis A 70-year-old man with BPH s/p TURP, hypertension, hyperlipidemia and stroke presents to the ED with acute onset of intermittent sharp left flank pain radiating into the groin that awoke him from sleep. He endorses nausea without vomiting and denies fever. He also endorses slightly decreased urination with “dribbling.” His urinalysis shows >100 RBC and no signs of infection. Nep ..read more

Written by: Maren Leibowitz, MD (NUEM ‘23) Edited by: Nick Wleklinski, MD (NUEM ‘22) Expert Commentary by: Zachary Schmitz, MD (NUEM '21) Expert Commentary This is an awesome, focused review of neuroleptic malignant syndrome (NMS). NMS is hard to diagnose because it's rare. There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). A tricky cause of NMS is the removal of a dopamine agonist. For this reason, carbidopa/levodopa should never be discontinued during hospital admission - or ED b ..read more