Emergency Medicine blog
Clinical teaching and practical ideas for your next study session.
When the Intubated Asthmatic Crashes: Auto-PEEP or Tension Pneumothorax?
In severe asthma, sudden post-intubation hypotension with high airway pressures is not automatically a tension pneumothorax. This case framework uses ventilator waveforms, pressure patterns, and the response to a brief disconnection while maintaining oxygenation as needed to recognize dynamic hyperinflation, then explains when chest decompression cannot wait.
Vancomycin in Febrile Neutropenia: How to Choose the Four SAQ Indications
The challenge in this febrile-neutropenia SAQ is not recalling vancomycin. It is distinguishing the four traditional high-yield clinical triggers from conditional modifiers such as MRSA colonization and mucositis.
When the Speculum Exam Stops: How to Finish the ED Evaluation Without Repeating the Assault
When a patient withdraws consent for a speculum exam, the next move is not persuasion. This ED framework shows how to separate urgent medical care, forensic options, prophylaxis, documentation, and follow-up so one declined component does not end the encounter.
Anaphylaxis With Stridor, Shock, and Propranolol: Do Not Let Glucagon Delay the Airway
In suspected food-triggered anaphylaxis with stridor, hoarseness, tongue swelling, wheeze, and shock, the key ED decision is when to secure the airway while epinephrine treatment continues. This case-based framework separates upper- from lower-airway findings, clarifies what propranolol changes, and avoids common rescue-therapy traps.
Amniotic Fluid Embolism: The 65/35 Shock Sequence
When hypotension persists after an initial crystalloid bolus in suspected amniotic fluid embolism, a strong SAQ answer shows parallel pressure support, RV assessment, and hemorrhage control—not another blind fluid bolus.
Warfarin INR 4.5 With Life-Threatening Bleeding: Why 4-Factor PCC and Vitamin K Must Be Paired
A focused ED framework for turning an INR of 4.5 into the correct 4-factor PCC dose, adding IV vitamin K, and avoiding delays, unnecessary plasma volume, and INR-driven errors.
When Septic Shock Looks Cardiogenic: A Bedside Framework for Mixed Shock in the ED
Fever, pulmonary crackles, cool skin, atrial fibrillation, and a high lactate can point in several directions. Learn to identify mixed shock without anchoring, overloading a failing heart, or delaying pressors and antibiotics.
Circumrescue Collapse: Emergency Medicine Board SAQ
A focused framework for defining classic and analogous rescue collapse, separating mechanical from physiologic contributors, avoiding common SAQ reasoning errors, and converting a short hypothermia prompt into a reliable retrieval exercise.
Rescue Collapse in Hypothermia: Why Gentle, Horizontal Handling Matters
Rescue collapse describes time-linked cardiovascular deterioration in a hypothermic patient during extrication, transfer, or early treatment. Understand the mechanical and physiologic mechanisms that make careful handling lifesaving.
Post-ROSC VF Arrest With ST Elevation and Cardiogenic Shock: What Cannot Wait
Persistent ST elevation after VF arrest demands simultaneous reperfusion, shock support, temperature control, and disciplined neurologic prognostication. This case-based review focuses on the decisions that cannot wait—and the findings that should not be overinterpreted.