Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. The seizure has lasted at least 12 minutes now, so this is status epilepticus. No information is available about her past history. The paramedics were unable to start an IV, but did […]
Hemoptysis can be scary. I covered the emergency medicine approach to massive hemoptysis in one of the early posts on First10EM. However, even when the hemoptysis is small volume, it can be quite distressing to patients and clinicians alike. This paper asks whether using nebulized tranexamic acid (or TXA) for […]
The “pink lady” or “GI cocktail”, a combination of an antacid and viscous lidocaine, is both much loved and much hated in emergency medicine. Some practitioners use it as a matter of routine. Others warn against it, for fear that it can lead to misdiagnosis in the setting of MI. […]
Last week, I discussed the reasons that I believe that tramadol is a bad drug that shouldn’t be prescribed. This week, I will tackle a similarly bad drug: codeine. The argument is essentially the same. Tramadol may be moderately worse, because of the added SNRI effects, but the variable effects […]
I have never prescribed tramadol. I was taught that, for a variety of reasons, it’s an awful drug. In Canada, everyone seemed to agree. But then I moved to New Zealand.
Status epilepticus is associated with a high degree of morbidity and mortality. Approximately ⅓ of patients have long term neurologic sequela, and mortality is 3-5%. (Chin 2006; Raspall-Chaure 2006) First line treatment is with benzodiazepines, but benzos will fail approximately 30-40% of the time. (Appleton 2008) Therefore, an effective second […]
I had the honour of being part of the final SMACC conference, as one of a series of people interviewed for a segment entitled “Pacific Island Playlist”. In preparation, I was asked to consider one piece of advice for the audience. My advice: be curious. Originally, I was thinking mostly […]
The AHA released an incredible scientific statement that goes through a ton of information on the use of education in improving outcomes from cardiac arrest. Really, the stuff they are discussing here applies to all of medical education, and anyone involved in teaching should probably read it. However, it is […]
