You are working an overnight shift in the emergency department when a 40 year-old male passenger involved in a high-speed motor vehicle collision arrives. His vital signs include a blood pressure of 88/56 mmHg, heart rate of 112, and respiratory rate of 16. His Glasgow coma score is 12 (3E, 4V, 5M). En route, your patient received 2L of normal saline with no change in his blood pressure. On exam, his abdomen is tender …
Tiny Tip: Anaphylaxis Treatment
Anaphylaxis is a common presentation to the emergency department requiring rapid treatment as death can occur within minutes. From 1986 – 2011, in Ontario, Canada alone there were 82 deaths from anaphylaxis (1). Epinephrine 0.5mg IM (1:1000) is the first line treatment for anaphylaxis and the only lifesaving treatment (2). The other medications are for symptomatic control or can help prevent the biphasic reaction anywhere from 8-72 hours from the initial reaction. For …
A Boring guide to Spinal Cord Syndromes
View PostMedical Concepts: Abdominal Pain Labs
A 40 year-old woman presents to your emergency department with a chief complaint of abdominal pain. Unfortunately, she does not speak English but an interpreter is being contacted. It is clear that she is in a lot of pain and she is not able to cooperate with your physical exam. Pain medication has been ordered and you are considering the workup that you need to get started. You wonder which investigations will be …
Tiny Tips: Epinephrine Dosage
Epinephrine is a commonly used medication in the emergency department for the management of anaphylaxis and cardiac arrest. Administering this drug can be confusing as the dosage and concentration are different for each indication. The “allergy epi” 1:1000 concentration is 10 times more concentrated than the “cardiac epi”. The “allergy epi” is delivered IM while the “cardiac epi” is delivered IV. This difference leads to an increased risk of error as the incorrect …
The ‘Top Five Changes’ Project: 2015 AHA guidelines on CPR + ECC update infographic series
Editor’s Note: Last Wednesday was like the night before Christmas for the BoringEM team. We had trouble getting to sleep as we awaited the Thursday release of the 2015 ILCOR / AHA / Heart & Stroke Foundation of Canada guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)! We spent the prior week planning for how our team could help to translate and disseminate this material to our readers, the #FOAMed community, and around the world. We are happy …