Not all of us work in busy trauma centers. And even for those of us who do, it can sometimes be confusing to manage suspected vascular trauma of the extremities. In last month’s EM:RAP, Mel interviewed our favorite trauma surgeon, Dr. Kenji Inaba, who has a real knack for breaking things down in a clear, straightforward way.

This is the third installment in a series focusing on the common overdoses that cause bradycardia, hypotension and altered mental status. Over the past several months during interviews with toxicologist Dr. Sean Nordt, we have discussed calcium channel blockers, beta blockers, clonidine and digitalis glycosides. All four classes of drugs can be fatal in overdose and all of them appear on the list of single tablets that can kill a child.

Overdoses that cause bradycardia and hypotension
Over the past several months, we have featured a series of interviews with our resident toxicologist, Dr. Sean Nordt, on the common overdoses that cause bradycardia and hypotension:

Recently on the EM:RAP podcast, we discussed the common presenting complaint of visual floaters and flashes. Our discussion was prompted by a recent piece in the JAMA Rational Clinical Examination series.(1) This is a great series of articles that examines the diagnostic utility of various clinical findings when considering important diagnoses in the setting of common presenting complaints.

You just sent someone home with peripheral vertigo . . . or was that a stroke? Before we break down an approach to vertigo, let’s briefly consider two questions: just how often does this “nightmare” scenario occur and does it really matter anyway?

In last month’s essay we discussed barotrauma, which occurs when gas in the body’s air-filled spaces shrinks with descent and expands with ascent. Perhaps the most common example of this is the diver that has trouble equalizing the pressure between their middle ear and the outside world due to a blocked or inflamed eustachian tube.

Dr. LoPresti has a knack for making sense of thyroid emergencies.  You’ll remember from last month that he used the term “decompensated hypothyroidism” instead of myxedema coma.  He explained that patients who are hypothyroid, and thus have a decreased metabolic rate, conserve heat by being in a constant state of vasoconstriction.  That is why they feel cool to the touch....