Lacerations are among the most frequently treated injuries in pediatric emergency care. The process of repairing these injuries can provoke considerable anxiety in children, which may lead to heightened pain, difficulty completing the procedure, and negative psychological and clinical effects (1-6). Midazolam is widely used to manage procedural anxiety in children, with intranasal administration gaining popularity in recent years. A recent study by Martin et al. explored both clinical and child-specific factors that may influence the effectiveness of intranasal midazolam (7).
Taylor Wahrenbrock, MD; Samson Frendo, MD; Eric Leser, MD; Joanne Routsolias, PharmD
Read MoreA 64-year-old male with a past medical history of atrial fibrillation on rivaroxaban (but not taking rivaroxaban for the past one week), myocardial infarction with multiple prior stents placed, heart failure with reduced ejection fraction, and hypertension presents to the emergency department (ED) with palpitations, dizziness, chest pain, and shortness of breath since 5:00 PM. At the time of initial assessment, the patient reports that his dizziness, chest pain, and shortness of breath have greatly improved since earlier tin the day and nearly resolved, though he is still having palpitations. An ECG is obtained immediately upon his arrival (Figure 1).
Taylor Wahrenbrock, MD; Michael Hohl, MD; Ari Edelheit, MD
Read MoreRetrograde intubation using a guidewire was first described in 1960. The technique involves puncturing the trachea (usually at the cricothyroid membrane) with a large bore needle (e.g. 16 gauge), passing a guidewire into the trachea, and then threading the guidewire cephalad. Once visualized in the oropharynx, an endotracheal (ET) tube can then be threaded over the guidewire and passed through the airway. This technique can be especially helpful in challenging obstructed or “dirty” airways with poor visualization of the vocal cords. A review article by Dhara is a great, comprehensive overview of the procedure (1). Several case reports and studies also suggest that this may be a procedure that should be considered by emergency physicians, rather than performing a cricothyrotomy, in the “cannot intubate, cannot ventilate” situation.
Kathryn McGregor, MD; Taylor Wahrenbrock, MD; Eric Leser, MD
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