alt“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.

altIn 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 perfect drug?

altYou 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.

altWe 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.

altThis 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.

altNovember's installment of the best of EM:RAP video discussing the article written by Stuart Swadron, MD in the November issue of EPMonthly.

altMany 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...

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