Essential Steps for Treating Toxicology Emergencies
A crashing toxicology patient is one of the most demanding presentations in emergency medicine. The history is often incomplete, unreliable, or unavailable. The bottle may be missing. The family may not know what was taken. The patient may be comatose, agitated, seizing, hypoxic, hypotensive, acidotic, bradycardic, hyperthermic, or in a wide-complex rhythm. In that moment, […]
Understanding BRASH Syndrome: Causes and Effects
BRASH Syndrome: Clinical Synergy & Pathophysiology BRASHInsight Overview Synergy Pathophysiology Treatment Goals Understanding BRASH Syndrome BRASH syndrome describes the interaction of bradycardia, renal dysfunction, AV-nodal blockade, shock, and hyperkalemia. This adult clinical overview explains the reinforcing cycle; it is not a diagnostic calculator or a complete treatment protocol. Treat this pattern as a working diagnosis. […]
Understanding Pain Stewardship in Emergency Care
Pain is one of the most common reasons patients come to the emergency department. Yet, despite modern analgesics, protocols, and guidelines, many patients still leave the ED having experienced unnecessary suffering. The updated European Society for Emergency Medicine guidelines remind us of a simple but often forgotten truth: pain management is not a single medication […]
Same Science, Different Systems: What the 2025 Korean CPR Guidelines Add to the AHA Update
Cardiac arrest guidelines are often read as checklists: compression depth, shock timing, drug doses, airway decisions, post-ROSC targets. But the most important message from the 2025 Korean Guidelines for Cardiopulmonary Resuscitation and the 2025 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care is broader than any single intervention. The field is moving from […]
Andes Virus and Hantavirus: Distinguishing Features and Risks
Peer-reviewed by Dr. Sabrina Berdouk. Hantavirus is one of those diagnoses most emergency physicians may never personally see—but when it matters, it matters fast. The early presentation can look like influenza, COVID-19, gastroenteritis, sepsis, pneumonia, myocarditis, or pulmonary edema. Then, in a subset of patients, the disease can abruptly transition into severe hypoxemia, shock, myocardial […]
Perform an ED Thoracotomy
By Abdolghader Pakniyat, peer-reviewed by Sabrina Berdouk A rare procedure, a narrow window, and one unforgettable survivor In my whole emergency medicine career, I have seen ED thoracotomy performed around seven or eight times. Only one patient survived. That number may sound discouraging. But anyone who has worked in a busy emergency department knows this […]
Differentiating Severity in Pulmonary Embolism Cases
Pulmonary embolism severity ranges from incidental disease to cardiopulmonary failure. This adult ED guide uses the 2026 AHA/ACC categories to explain risk assessment, disposition, anticoagulation and escalation. It is an educational framework; drug doses and procedural decisions need patient-specific prescribing and specialist review. It is a spectrum. At one end: the incidental, asymptomatic PE found […]
The Real Causes of ER Crowding and Their Solutions
After years in emergency medicine, I am wary of explanations that stop at the waiting room. Crowding has several causes, but when admitted patients cannot reach appropriate staffed beds, the ER carries the consequences. That deserves hospital-wide attention. Those upstream and downstream constraints are the focus here. Flow, resistance and reserve provide a useful analogy […]
Effective ED Management of Pulmonary Embolism
A practical, evidence-based approach to pulmonary embolism diagnosis in the ED Pulmonary embolism diagnosis in the emergency department starts with clinical probability and an assessment of stability. This adult-focused guide covers PERC, D-dimer, imaging and initial treatment decisions. Pregnancy needs a dedicated diagnostic pathway. Drug doses and local escalation arrangements should be checked against the […]
Understanding Polymorphic VT: Key Differences and Management
Scope: Adult polymorphic ventricular tachycardia. For sustained episodes, immediate unsynchronized shock takes priority over QT analysis. Subsequent treatment depends on the baseline QT, cause and specialist assessment. The key question is not “Is the QRS changing?” The key question is: Is the QT interval prolonged or not? Assess the QTc on an ECG after termination […]
Effective Pad Placement for Cardiac Arrest
In adult cardiac arrest, pad placement matters. But not because one position is clearly superior. It matters because good placement helps the shock reach the heart. That is the goal. You need enough current to pass through the myocardium and terminate ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). First principle: do not overcomplicate pad […]
The Perfusion Gap: Why “Good” Teams Fail at CPR (And How to Fix It)
By Abdolghader Pakniyat, peer reviewed by Sabrina Berdouk 1. Introduction: The Perfection Paradox Knowing the adult arrest algorithm is only the starting point. The team must apply it while several urgent tasks compete for attention. This article focuses on preventable gaps in execution. A poor outcome alone does not establish that the team delivered poor […]