“Who in their right mind would take an inch and a half needle, fill it
with some bupivacaine, and stab somebody in the back of the neck to get
rid of their headache?”
An ALTE, or apparent life-threatening event, is defined somewhat
nebulously. Essentially, it is a frightening episode involving a
combination of apnea, change in color or tone, choking or gagging. The
differential diagnosis for an ALTE is broad, ranging from relatively
benign conditions such as gastro-esophageal reflux to congenital heart
disease or child abuse.
In October’s EMRAP, Dr. Sanjay Arora discussed procedural sedation and
analgesia (PSA) with Mel Herbert. Their discussion centered on ketofol,
the combination of ketamine and propofol, which has been proposed as an
ideal agent for PSA. The question of the hour: Could Ketofol be the
You walk into your next code and it’s a man in his 60s who collapsed on
his way to his cardiologist’s office. His wife insists that he doesn’t
need CPR because he has a kind of artificial heart, an LVAD. No one in
the department has ever seen a patient with one of these before.
We just finished a two-part series with one of our former Chief
Residents, Dr. Zachary Shinar. Zach has been working in San Diego at
Sharp Memorial Hospital and more recently at UC San Diego. What he has
been up to down there is nothing short of incredible.
This is the second installment of a piece based on an interview by Dr.
Rob Orman with Dr. Megan Cavanaugh, a colorectal surgeon in Portland,
Oregon. Although many of Dr. Cavanaugh’s recommendations are not based
on controlled trials, listeners nonetheless found the interview very
helpful. Her advice is straightforward and practical, with a good
measure of humor mixed in.
November's installment of the best of EM:RAP video discussing the article written by Stuart Swadron, MD in the November issue of EPMonthly.
Many of us are a little tentative when dealing with emergency
presentations of ano-rectal disorders. A couple of months ago, we
featured an interview by Dr. Rob Orman with Dr. Megan Cavanaugh, a
colorectal surgeon in Portland, Oregon. The interview was surprisingly
popular because Dr. Cavanaugh was a great sport and didn’t hesitate to
weigh in candidly on our most common concerns.
For a generation of American physicians, the tragic and infamous case of Libby Zion evokes a multitude of feelings. Although the case is best remembered for the enduring effect it had on resident duty hours, for many of us it was the first time that we became familiar with the serotonin syndrome and the seemingly obscure drug interactions that can cause it.
A couple months ago on EM:RAP, Mel and I had a discussion about delirium tremens (DT). We see a lot of patients in our emergency department with this most severe form of alcohol withdrawal. On some shifts it seems as common for us at L.A. County/USC as STEMI or appendicitis. In order to qualify for this diagnosis, patients must have...