Contributor: Travis Barlock, MD Educational Pearls: First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma. Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt How to improve likelihood of first-pass…
Read MoreContributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point…
Read MoreContributor: Meghan Hurley, MD Educational Pearls: 1. Initial Assessment Start with a physical examination: Determine if the bleed is anterior or posterior. Perform a primary survey: assess airway, breathing, and circulation (ABCs). Airway compromise = intubation immediately. If the patient is stable, have them blow out any clots, then re-examine the nares. 2. Topical Medications…
Read MoreContributor: Ricky Dhaliwal, MD Educational Pearls: Angioedema in anaphylaxis Histamine and mast cell-mediated pathway Treatment: First line: epinephrine for vasoconstriction and bronchodilation Second line: H1 and H2 antihistamines such as Benadryl and famotidine ACE inhibitor-induced angioedema Different pathway from anaphylaxis ACE inhibitor-induced angioedema is mediated by bradykinins Therefore, anaphylaxis medications are not beneficial in patients…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Pediatric case study where the child’s tongue was stuck in the opening of a hard plastic drink lid Entrapment restricts circulation which causes fluid to build and the tongue becomes more edematous with time There is a risk of ischemia with prolonged entrapment Initially tried 2% viscous lidocaine for…
Read MoreContributor: Megan Hurley, MD Educational Pearls: Fevers Tylenol Up until 20 weeks NSAIDs are ok but after 20 weeks they are contraindicated Can limit the amount of amniotic fluid produced Can lead to growth restriction Can cause premature closure of the ductus arteriosus Cough Cough drops Humidifier Guafenesine and dextromethorphan (Mucinex) is not well studied…
Read MoreContributor: Meghan Hurley, MD Educational Pearls: Educational Pearls: Dental infections can be categorized into two main groups Infections of the gums Pericoronitis Tooth eruption leading to inflammation/irritation Can progress to an infection Requires pain control, no antibiotics Gingivitis Inflammation of the gums Can lead to an infection requiring antibiotics Abscess (gums) If an infection develops…
Read MoreContributor: Jarod Scott, MD Educational Pearls: There is a 1-hour window for tooth replantation in ED Cold milk is often best transport media unless there is access to specialized solutions (Hank’s Balanced Solution) Goal is to preserve periodontal ligament Soaking in tap water should be avoided as it will lyse cells of periodontal ligament If…
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tastes so good, hurts so bad Chief Complaint: Esophageal Foreign Body HPI: 31-year-old male presents to emergency department with reports of an esophageal foreign body. He states that he was eating chicken and had a large piece of chicken get stuck in his chest. He is vomiting up liquid after attempts of swallowing water, not…
Read MoreContributor: Jared Scott, MD Educational Pearls: Often present with complaints of sore throat, pain with swallowing, difficulty swallowing, voice change, and possible fever Retrospective study from 2018 evaluated outcomes of peritonsillar abscess with two management arms, surgical vs. non-surgical treatment Non-surgical treatment only included IV fluids as well as IV ceftriaxone + clindamycin; Surgical treatment…
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