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Disruptive technology in PEM: A case for emergency ultrasound

Last week, a patient with systemic lupus arrived in the Emergency Department complaining of shortness of breath. She was mildly tachypneic and uncomfortable with any movement. A chest radiograph was ordered. While she waited, I did a quick bedside ultrasound (shown above), revealing a large right-sided pleural effusion, extending all the way to her axilla. Her bedside echo did not reveal a pericardial effusion. I went ahead and began planning her inpatient pleurocentesis. The CXR was done soon after and was read as possible effusion versus infiltrate of the right sided. How has my practice Read more [...]
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Answer: “This Is Spinal Tap.”

This post is in response to the post “This is Spinal Tap.” To summarize, this was a 3-week old boy who required a full septic work-up after he presented to the ED with a fever.   You performed a point-of-care ultrasound to help identify potential spaces to perform the tap and obtained 3 images. A                                                      B                                                      C   Thank you to everyone who took the quiz! 100% of you guessed correctly Read more [...]

Promotions and Academic Scholarship, Part II – Types of Scholarship

To view Part I, click here Today, we're going to discuss the types of scholarship - or, if you want to get really academic, as in the tweed jacket, brandy-swilling, elbow patches pontification academic - the domains of scholarship.  For those of us in basic sciences research, your type of scholarship is fairly linear and obvious: Kill rats and isolate their genetic whatever. Publish randomized control study research results like crazy. Get a zillion dollars in funding. For those of us not in basic sciences research, it's a little murkier.  In fact, even for those in Read more [...]

Getting testy: Parents who demand tests in the ED and doctors who may or may not order them

There are many demands in the emergency department. Perhaps the most important ones come from patients and their families. This post originally appeared on PEMBlog.com as a part of the Art of Medicine series and looks at those situations in which patients/parents are requesting - nay demanding specific tests. As I noted in a previous post in this series the ED is an emotionally charged environment. Often parents are seeking an answer as to why their child is ill. That answer may come in the form of a specific diagnosis or further elucidation as to the reason for particular symptoms. I'm sure Read more [...]
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This is Spinal Tap.

  This was a 3-week old otherwise healthy full-term boy who was brought in by his parents for a fever of 100.8F rectally at home. Parents are extremely concerned because their firstborn baby is dehydrated because he has not been drinking very well all day with 1 wet diaper. Parents deny any cough, rhinorrhea, vomiting, diarrhea or rash.   You explain to them that you will need to do a full septic work-up, which will include blood, urine and CSF studies. They are extremely anxious about the lumbar puncture, and ask if there is anything you can do to ensure a more successful Read more [...]
Frozen (2013)Olaf (voiced by Josh Gad)

Brr it is frreeezzing out there… (are you really not dead until your warm and dead?)

A five year old patient comes into the ED after falling through the ice on their pond playing hockey.  He  had on scene CPR for 10 minutes and you have now continued CPR for 20 minutes. The classic pediatric teaching is-- the patient is not dead until they are warm and dead.  We are trained to continue CPR because of case reports of "miracle" neurologic outcomes in pediatric cold water drowning patients with prolonged submersion (> 60 minutes).  The "Guinness" book of records reports survival in children with temperatures as low as 15C and CPR for up to 6.5 hours.  Rewarming these Read more [...]

Doctor Cents–There is NO price too LOW for BAD advice!

In the last post we talked about the importance of making a financial plan. This concept rightfully scared some of you. Hopefully this post will help ease some anxiety regarding your personal financial plan by helping you determine how you are going to make your personal financial plan. As a PEM fellow or PEM attending you will be approached by many different individuals who want to “help” you do financial planning (if you haven’t been approached already). Financial advisors usually come in one of four flavors: commission based employee of a brokerage firm or insurance company fee Read more [...]