Femoral nerve blocks for hip fractures: the evidence

A deep dive into the evidence for providing femoral nerve blocks for patients with hip fractures

The most recent topic that Rory Spiegel, Anton Helman and I covered for the Emergency Medicine Cases Journal Jam is femoral nerve blocks for hip fractures. This is my summary of the evidence. Continue reading “Femoral nerve blocks for hip fractures: the evidence”

Adverse drug reactions in the emergency department (Hohl 2018)

Can a decision tool help us identify patients at risk for adverse drug reactions in the emergency department?

Adverse drug events might be responsible for as many as 1 in 9 emergency department visits.1,2,3 Physicians frequently miss the diagnosis of medication related adverse events.4,5,6 Pharmacists can be very helpful in assessing patients for adverse drug events, but are a scarce or non-existent resource in most emergency departments. This paper asks whether clinical decision tools can help us identify adverse drug reactions among emergency department patients.

Continue reading “Adverse drug reactions in the emergency department (Hohl 2018)”

Massive Hemorrhage Post-Tonsillectomy

The initial emergency medicine management of post-tonsillectomy bleeding


A ten year old boy presents with significant bleeding from his mouth and nose. He is learning forward, and although blood is rapidly pouring onto the stretcher, he is able to tell you his name. Two very anxious appearing parents are at the bedside, and are able to tell you that he had a routine tonsillectomy performed 5 days ago…

Continue reading “Massive Hemorrhage Post-Tonsillectomy”

Respiratory distress in the patient with a tracheostomy (update)

A summary of the emergency medicine approach to respiratory distress in the patient with a tracheostomy

This is an update of a previous version of this post. I am reposting to coincide with the release of a new textbook that I am pretty excited about. The textbook is the Resuscitation Crisis Manual. It provides very succinct action scripts for the major emergencies that we see. It is exactly the textbook that I always wanted in residency, but didn’t exist. The absence of this kind of resource was exactly the reason that I started First10EM. (Perhaps, in the future, Scott can just keep me up to date on his projects. If I had just waited a couple years, I could have had the textbook without feeling like I had to write it by myself.) I wrote the “Tracheostomy Emergencies” chapter of the book – hence the decision to repost this topic. (I guess I should note that I don’t get anything for writing that chapter, so I don’t have any financial conflicts of interest – just intellectual biases.)

If you want to hear more about the book, check out this EMCrit podcast.


A 45 year old man, well known to your department because of a prior anoxic brain injury and multiple complications including a permanent tracheostomy, is brought in by ambulance from home in respiratory distress. You know from prior conversations with the family that the patient is to receive full, aggressive medical management. He is using every accessory muscle that you can see, his respiratory rate is 55, and his oxygen saturation is 87% on room air…

Continue reading “Respiratory distress in the patient with a tracheostomy (update)”

Paramedic 2: Epinephrine harms/helps in out of hospital cardiac arrest

A critical appraisal of the PARAMEDIC 2 trial (epinephrine in out of hospital cardiac arrest)

After years of waiting, PARAMEDIC 2, the large RCT of epinephrine for out of hospital cardiac arrest, has finally been published. So we can now definitively say that epinephrine is harmful. Wait, maybe it helps? Can a positive study demonstrate harm? Maybe this EBM stuff isn’t so easy after all

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Articles of the month (July 2018)

A monthly (ish) summary of the emergency medicine literature

You will probably notice a new format to the articles of the month. I was getting sick of not being able to find papers that I knew I had previously commented upon. Having them listed as one 10 papers in the articles of the month made them very difficult to search for. Therefore, on bigger, more important papers, I have started writing stand alone blog posts. I will still include those papers in the articles of the month, but the summary will be truncated, with a link to the blog for all the details. The articles of the month will probably still contain extra articles, including papers that don’t warrant their own post and my usual “just for fun” kind of papers. Let me know what you think. Continue reading “Articles of the month (July 2018)”

I said “quiet”

Does saying “quiet” really cause chaos?

I did it again. I was at the nursing station in our resuscitation area and I commented on how quiet the night had been so far. Of course, all hell broke loose. Continue reading “I said “quiet””