• Do not have to start in the RUQ for eFast every time
• If eFast is possible in one view, do not have to continue to all views
• When looking for pneumothorax: Lung slide, lung point, lung pulse, B lines
  • Lung slide- no ptx when present, possible when absent
  • Lung point- ptx when present, no ptx when absent
  • Lung pulse- no ptx when present, maybe ptx when absent
  • B lines- no ptx when present
• Serratus block- anterior and lateral ribs, no posterior ribs
• Local anesthetic systemic toxicity
  • Perioral numbness, metallic taste, muscle twitching, seizures, unconsciousness, bradycardia, AV block, tachyarrythmia, hypotension, cardiac arrest
  • Treatment- intralipid

Dr. Graham- Necrotizing soft tissue infections

• Symptoms- erythema, swelling, crepitus, fevers, pain out of proportion to exam, hypotension, hemorrhagic bullae
• Labs- leukocytosis, elevated inflammatory markers, elevated creatinine, hyperglycemia, hyponatremia
• Imaging- CT with gas in subcutaneous tissue, fat stranding
• Treatment- fluid resuscitation, triple antibiotics (broad spectrum- meropenem or zosyn, MRSA- vancomycin, antitoxin- clindamycin), surgical consult

Dr. Stewart- SJS/TEN

• SJS- less than 10% total body surface area
• Overlap SJS/TEN- between 10 and 30% total body surface area
• TEN- greater than 30% total body surface area
• Causative medications- allopurinol, anticonvulsants, sulfa drugs, antibiotics
• Labs- CBC, CMP, inflammatory markers
• SCORTEN- severity of illness score for TEN
• Management- fluid replacement, temperature control, +/- steroids
• Dispo- trauma/derm/burn unit

Dr. Firquin- Pediatric respiratory emergencies

• Croup- URI symptoms, fevers, stridor, barking cough, symptoms worse at night, hypoxia is uncommon
  • Corticosteroids (0.6mg/kg with max 16mg), racemic epinephrine
• Bronchiolitis- URI symptoms, tachypnea, peak at <12months, retractions, poor PO
  • HFNC, suction
• Foreign body aspiration- cough, stridor, tachypnea, sudden episodes
  • XR, bronchoscopy
• Asthma- wheezing, cough, triggered by viral illness
  • Albuterol, ipratropium, steroids
  • Magnesium- side effects of bradycardia and hypotension
  • Epinephrine IM 0.1mg/kg for severe cases
  • Terbutaline for severe cases
  • Consider CXR on first time wheezer

Dr. Smith- Cutaneous ulcers

• Diabetic foot wound- neuropathic ulcer over bony prominences of foot, cover for MRSA and pseudomonas for infection, non-infected wounds can be discharged with outpatient follow-up
• Venous stasis ulcer- caused by poor venous return, shallow ulcers with irregular borders, wet to dry dressings, elevation of leg, compression stockings, oral antihistamines for itching
• Pressure ulcer
  • Stage 1/2- dressing changes, padding for pressure relief
  • Stage 3/4- debridement, wound care, ongoing pressure relief
• Arterial insufficiency ulcer- usually able to be managed as outpatient as long as patient has good capillary refill, pulse
  • Pulseless- CTA, trauma consult
• Calciphylaxis- ESRD patients, deposition into arteries, rapidly progressive lesions
  • treatment with calcium control and possible surgical intervention

Dr. Leasau- DRESS

• Morbilliform rash >50% of skin, facial swelling and edema, fever 
• Negative nikolsky sign
• 2-6 wk after new drug
• Common drugs: phenytoin, phenobarb, carbamazepine, allopurinol, sulfa drugs
• Treatment: discontinue offending drug, supportive care, +/- corticosteroids

Dr. Drury- abscesses

• Erythematous nodules, forming pus filled cavity anywhere on the body

• Mostly MRSA, some MSSA but can be any skin flora or fungi
• Consider consulting: perirectal, involvement of tendon sheaths, large size, pulsatile mass
• POCUS
  • Abscess- pocket of localized anechoic fluid
  • Cellulitis- cobblestoning
• Treatment: I&D, most will require antibiotics unless simple/single abscess and low risk

Dr. Shoff- patient experience

• When you triage a patient from room 9,  let the patient know what is happening before you roll them out
• Tell patient the buzzer means a trauma or a stroke that is an emergency, will be right back as soon as you are done
• Recap room 9 findings and tell patient what next steps are before you send the patient to CT
• Tell patient plan for the visit prior to leaving the room when you first see them
• Ask the patient what they are concerned about, tell them how you are going to address that concern

Dr. Klaszky- Invasive Mechanical Ventilation in the ED

• Starting settings: PEEP 5, TV 6ml/kg IBW, RR 16-18
• Modes of ventilation:
  • AC: full support, set RR, if patient breathes over that rate- ventilator takes over
  • SIMV: moderate support, set RR, if patient breathes over that rate- patient does the work of breathing
  • PS: minimal support, no set RR, patient does most of the work of breathing
• VC: set tidal volume, monitor pressure (peak/plateau) 
• PC: set pressure, monitor tidal volumes
• Combining AC with VC or PC
• Targeting sat with FiO2 is 88-95%
• ARDS- PEEP responsive
• Plateau pressure- want to keep less than 30 to avoid injury to the lung
  • Tidal volume and PEEP affect plateau pressure, can decrease one or the other if need to get plateau pressure below 30
  • If you have to drop tidal volume, will need to increase RR to get same minute ventilation, often have to increase to mid/upper 20s, low 30s 
• Alveolar ventilation = TV – dead space

Dr. Hudson/Dr. Blair- airway procedure sim

• LMA: supraglottic tube + mask with inflatable cuff that sits above vocal cords
• NPA: uncuffed tube inserted via nose that sits in posterior oropharynx
• OPA: rigid, inserted into the mouth resting behind the tongue to prevent tongue obstruction of airway
• Cricothyroidotomy: can’t intubate, can’t oxygenate