POCUS Quality Assurance in Emergency Medicine: 4 Essential Pillars for Safe Point-of-Care Ultrasound
We have won the battle for POCUS adoption. Now we must win the battle for quality. In the world of Emergency Medicine and Critical Care, the debate is largely over. We all believe that Point-of-Care Ultrasound (#POCUS) is the superior way to approach the undifferentiated patient. We fought for years to get the machines into […]
What to do in the ED for ICU boarder patients
ICU boarding isn’t just a logistics problem—it’s a biology problem. Time outside an ICU environment increases the chance of secondary injury: hypotension, fluid overload/venous congestion, VILI, delirium, VTE, stress-related UGIB, iatrogenic AKI, and delayed antimicrobial optimization. Principle: once a patient is accepted for admission, the system must deliver ICU-level care regardless of geography—and hospital policy […]
Hydration for Acute Ischemic Stroke in the Emergency Department
We all know the “dry stroke” patient: older, hypertensive, hasn’t been drinking, comes in tachycardic with a sticky tongue and a BUN/Cr that’s not pretty. A recent study suggests that giving these patients more fluid early might reduce early neurological deterioration (END). But how far should we go in the ED? A new single-centre before–after […]
Plethoric IVC in the ED — does it mean congestion?
You scan the subcostal view and the IVC is big… barely moving with respiration. The reflex is: “They’re fluid-overloaded / congested.” Sometimes that’s true. Often it’s not. A plethoric IVC is best treated as a clue to elevated right‐sided filling pressure (RAP) or altered transmission of pressure—not a standalone diagnosis of “congestion.” What “plethoric IVC” […]
Ketamine vs Etomidate for RSI in the Critically Ill: What This NEJM Trial Really Tells Us
For years, emergency and critical care clinicians have debated which induction agent is best for hemodynamically unstable intubations, especially in sepsis. Two big beliefs have dominated: A recent NEJM trial comparing ketamine and etomidate for emergency intubation in critically ill adults gives us the best data we’ve ever had to answer a simple question: If […]
Pain Is Not a Vital Sign – But It Is Vital
Rethinking Pain Assessment in the Emergency Department For years, we’ve been told to treat pain as “the fifth vital sign.” The intention was noble: recognize pain earlier, take it seriously, and treat it better. But in the ED, this concept has created as many problems as it tried to solve—especially when it’s interpreted literally and […]
Acute Vertigo Management: Using STANDING for Quick Assessment
Reviewed by Dr. Sabrina Berdouk On a busy ED shift, “dizziness” is the chief complaint that can feel both benign and terrifying at the same time. Most of these patients will have BPPV or vestibular neuritis. However, a small but critical minority will have a posterior circulation stroke—and these are the ones we absolutely cannot […]
Critical Steps for Massive PE Resuscitation
Reviewed by DR. Sabrina Berdouk You’re in resus. The patient is hypotensive, tachycardic, gasping. CT (or echo) screams PE. The right ventricle is huge and unhappy. This is the moment where clarity beats complexity. This post is a practical, physiology-rooted cheat sheet for high-risk (massive) PE – the patient who is shocked or in arrest […]
Vital Signs in the ED: What They Really Mean
In the emergency department, “vital signs” are often treated like routine admin data: They get recorded, clicked, and scrolled past. But this chapter makes one thing very clear:vital signs are the body’s language under stress. If we read them well, we can catch trouble early. If we misuse them, we get fooled. 1. One set […]
Avoiding Common Pitfalls in Post-Arrest Treatment
Why It Matters:After cardiac arrest, the risk of secondary brain and cardiac injury is highest in the first hours—where missteps in oxygen, ventilation, hemodynamics, temperature, or diagnostics can worsen outcomes. Here’s how to anchor your post-arrest care in physiology and avoid common pitfalls. Airway & Oxygenation Pitfall: Physiology:Post-arrest neurons are “primed” for oxidative damage: excess […]