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Performance Under Pressure

How well do you perform when the pressure is high? This is one of my favorite emergency medicine topics. Emergency personnel pride themselves on thriving under pressure. Doctors like to think of themselves as perfect, maybe even god-like. Combine the two, and you can imagine the ego of the average emergency physician. But underneath all that bravado, we are all human. We all experience stress, and we all respond to stress in distinctly human ways.

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Articles of the month (May 2017)

I took another month off, but the blog and accompanying podcast are back with what I think is an interesting collection of articles… Continue reading “Articles of the month (May 2017)”

Quick PESIT update

By now, everyone has (unfortunately) heard about the PESIT trial. Given the many commentaries in the FOAM community, we are all familiar with the many reasons that the widely quoted 1 in 6 figure probably does not apply to our patients. If you need a reminder, I summarize the paper as part of this post, or you can read a more elegant post by Rory Spiegel here. For me, the biggest issue was that PESIT never passed the sniff test. We see a ton of syncope patients. There are massive syncope databases. And nowhere have we seen massive numbers of patients returning with PE.

A research letter was just published yesterday in JAMA that gives us another take on the issue: Continue reading “Quick PESIT update”

Ultrasound for pediatric forearm fractures (SGEM HOP)

The most recent episode of the SGEM hot of the press series came out today. The article we reviewed was looking at the utility of point of care ultrasound in pediatric forearm fractures:

Poonai N, Myslik F, Joubert G et al. Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes. Acad Emerg Med. 2017. Continue reading “Ultrasound for pediatric forearm fractures (SGEM HOP)”

Sweet 16 (papers of the year for NYGH EMU 2017)

At this year’s North York General Emergency Medicine Update, I was asked to review the most important emergency medicine literature from the past year. These are the 10 papers I decided to talk about. If you have questions or comments, please join the discussion at the bottom of the post.

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The conversation that extended my career

We all mistakes. It’s better to talk about them.

My heart is pounding. My stomach is in a knot. I can’t think straight.

I made a mistake. Continue reading “The conversation that extended my career”

UTI: More than you ever wanted to know

For this month’s Emergency Medicine Cases, Anton kindly asked me to act as a guest expert on the topic of urinary tract infections. The episode, which I think is fantastic, can be found here. In preparing for the episode, I ended up reading a lot, learning a lot, and taking relatively extensive notes. Although it doesn’t fit with the usual content of First10EM, I decided to share my notes, as I think some people might find them interesting, and they also provide links to all the literature we mention in the podcast. Continue reading “UTI: More than you ever wanted to know”

Chloral Hydrate Toxicity

A guide to the first 10 minutes of resuscitation in chloral hydrate toxicity

Case

#1 A 4 year old girl was prescribed chloral hydrate to be taken at home prior to a procedure by her dentist. After a successful procedure, she was monitored for 1 hour, at which point she was described as tired but rousable and she was discharged home. Three hours later her mother finds her unresponsive and calls 911. Paramedics arrive to find a child in respiratory arrest and quickly package her up for the 5 minute drive to your small community hospital… (Nordt 2014)

#2 Later that evening, a 21 old man is transported from a local bar unresponsive after drinking a beer. The monitor reveals a wide complex tachycardia. There is a faint odor of pears on his breath, which triggers a vague recollection from medical trivia night. You have a nurse talk to his friends, and sure enough, they admit to slipping him a “Micky Finn” as a prank…

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