When I was a little kid, I was always asked the question, “So what do you want to be when you grow up?” I would answer emphatically, “That’s easy- a journalist.” Why? I have always found the profession to be quite fascinating. The work that it entails- researching and writing to deliver a news story to be shared with an audience of readers, listeners, and viewers- is right up my alley. Even as a kid, [...]

The case: TR is a 55-year-old African American male who is sent to your emergency department after his primary care physician receives the results of recent routine bloodwork performed earlier that day, revealing a white blood cell count (WBC) of 2700 and an absolute neutrophil count (ANC) of 1350. He has a past medical history of paranoid schizophrenia, and for this, he is currently taking clozapine 150 mg by mouth twice daily as an outpatient. [...]

The risk of contrast induced nephropathy (CIN) in cardiac patients undergoing primary cardiac catheterization is approximately 5%.[1] With associated risk factors (Table), that risk can jump to 50%.  Pertaining to cardiac cath, administration of high volumes of contrast intra-arterially confers a higher risk compared to patient populations such as trauma patients who require radiologic imaging with contrast.[2]  Additionally, while similar risk factors may be present, trauma patients tend to be younger and generally healthier compared [...]

Below is a table of common medications used in the emergency department that require dose adjustments based on weight in the obese patient: Important notes: ABW = actual body weight (kg) IBW = ideal body weight (kg) Calculation: Males: 50 + (2.3 x number of inches over height of 60") Females: 45.5 + (2.3 x number of inches over height of 60") AdjBW = adjusted body weight (kg) To be used if ABW is at least 120% [...]

If a patient presents in rapid Afib and is currently taking a beta-blocker, should a beta-blocker be used for rate control? Conversely, if a similar patient presents, but is taking a calcium channel blocker, should a ccb be used for rate control?  I was asked this question years ago.  Essentially, the concern was that if a ccb and a beta-blocker were combined, additive (if not synergistic) cardiac depression would occur. The specific concern was a [...]

Gonococcal infection is a growing public health problem that continues to remain of concern in the United States. Infection can occur in a number of anatomical sites, including the urethra, rectum, oropharynx, eye, and endocervical canal. Complications of untreated infection may lead to damage of reproductive organs, which may include pelvic inflammatory disease, infertility, and ectopic pregnancy in females, as well as disseminated gonococcal infection and conjunctivitis in neonates. With all of these potential complications, [...]

There is much discussion lately regarding new reversal strategies of oral anticoagulants that are rapidly growing in popularity.  While the data to support the use of agents like PCC and aPCCs are limited, our clinical experience is also lacking.  So-called ‘old school’ reversal agents, though infrequently used, still have a place for patients who receive parenteral anticoagulation.  Protamine sulfate, our favorite salmon sperm derived drug, was (and still is) our go to reversal drug for [...]

The case: TR is a one-year-old infant who presents to your emergency department with a tonic-clonic seizure. According to the paramedics, the seizure has lasted for approximately 10 minutes. She has no known past medical history. Vital signs are relatively stable, and a bedside blood glucose is performed, revealing a level of 105 mg/dL. She has a weight of 10 kg. IV access is established and 1 mg of lorazepam IV push is administered. The [...]

The case: TR is a one-year-old infant who presents to your emergency department with a tonic-clonic seizure. According to the paramedics, the seizure has lasted for approximately 10 minutes. She has no known past medical history. Vital signs are relatively stable, and a bedside blood glucose is performed, revealing a level of 105 mg/dL. She has a weight of 10 kg. IV access is established and 1 mg of lorazepam IV push is administered. The [...]