The bleeding tracheostomy
On another shift, the 45 year old man with a tracheostomy from the prior case is brought back into the emergency room. This time, he is actively bleeding from his tracheostomy site... My approach G...
Read ItJustin Morgenstern
Papers Published
Respiratory distress in the patient with a tracheostomy
A 45 year old man, well known to your department because of a prior anoxic brain injury and multiple complications including a permanent tracheostomy, is brought in by ambulance from home in respir...
Read ItA general approach to resuscitation
The objective of First10EM is to review specific emergency medicine scenarios that require urgent action, allow little time for thought, and therefore benefit from a pre-thought out plan. However, ...
Read ItCardiac arrest in pregnancy: the perimortem cesarean section
The bat phone rings, and through the static of the EMS patch, you hear that they are 2 minutes out with a 36-year-old woman in PEA, but you couldn't hear that last bit. After 3 more attempts (maybe...
Read ItLVADs: Trouble shooting left ventricular assist devices in the emergency department
A 74 year old man is brought into the resus room at your community hospital. He has an altered level of consciousness, but is still rousable. EMS is quite concerned because he doesn't have a pulse....
Read ItVP shunt malfunction
A 4 year old presented to the ED with a mild headache, nausea, and vomiting, and was triaged to the sub-acute area of the department. You are called to the room stat, as the child is now unresponsi...
Read ItUndifferentiated hypotension
"Doctor to resus 2, stat", and you just stepped into the department. There hasn't even been time for a sip of coffee or a washroom break after the commute in. In the resus room, you are greeted wit...
Read ItLocal anesthetic toxicity
You are looking after a 30 year old woman with an isolated femur fracture, and decide to help manage her pain with a nerve block. Unfortunately, your ultrasound machine was broken so you attempted ...
Read ItProcedure: Lateral Canthotomy
A 21 year old man was minding his own business on a street corner, when out of nowhere two dudes just jumped him. His primary injury appears to be to his right eye. He is complaining of a lot of ey...
Read ItMassive Hemoptysis
The charge nurse grabs your arm and pulls you into the resuscitation bay, where EMS have just unloaded a 45 year old guy in obvious distress, coughing up a significant amount of blood. The paramedi...
Read ItProcedure: Umbilical Vein Catheterization
You find yourself leading a code pink in L&D, with no pediatricians to be found. You have already moved efficiently through the neonatal resuscitation algorithm, but despite clearing the airway...
Read ItNeonatal (Newborn) Resuscitation
Code pink in labour and delivery, and you are the only doctor in the hospital tonight... My approach Call for help. Hopefully the code pink activated the pediatrician already. I like to bring a sec...
Read ItThe Simplified Approach to PEA (non-traumatic)
A 60 year old woman is brought into your resus room VSA with CPR in progress. The paramedics tell you that she had a witnessed arrest and bystander CPR was performed for 4 minutes before they arriv...
Read ItThe Difficult Delivery: Umbilical Cord Prolapse
Once again, a 34 year old G5P4 woman at 39 weeks gestation is wheeled into your resus room in what appears to be precipitous delivery. You perform a quick exam, but instead of encountering the pres...
Read ItThe Difficult Delivery: Breech Presentation
A 34 year old woman G5P4 at 39 weeks gestation is wheeled into your department, and your nurses tell you to get ready: she is crowning! You examine the patient, and sure enough she appears to be cr...
Read ItThe Difficult Delivery: Shoulder Dystocia
You are proceeding with the precipitous delivery described in the previous post. You have just delivered the head, but it seems to pull back. No further progress is being made. As you stare down at...
Read ItPrecipitous delivery in the ED
You are chatting with your triage nurses on a slow night shift when a car pulls up to the front doors. A 34 year old woman G5P4 at 39 weeks gestation is wheeled up to triage by a slightly panicked ...
Read ItLaryngospasm
A feisty 3 year old tripped, cut her lip, and is now politely refusing your colleague's attempts at suturing. You hear these polite refusals from across the department, and wander over to offer you...
Read ItTet Spell
A 2 month old boy is brought into the resus room of your community hospital looking completely blue. The mother rather anxiously states that they have been followed at the large pediatric hospital ...
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