Our pt. drops their Hct, gets a finger in their rectum and is dx w UGIB. Rule of thumb- when dysrhythmia and low BP, the higher the HR goes above 150, the more fixing HR will improve CO and BP. Be careful shocking A. fib especially, be wary of an underlying cause of shock.

‼️ Attention rising MS4's applying this cycle! ResidencyCAS will be opening on June 4! Make sure to contact your school's student affairs office for your individual access link! Canadian students please email CARMS and IMGs please contact ECFMG! ‼️

EM low sodium for dummies: Is it real? Serum Osm tells you. Is there ADH? Urine sodium tells you. SHOULD there be? Urine Osm tells you. Order those, EM folks.

Case of the obtunded tachypneic pt: Pt with pH 7 HCO3 6 AG 38 Lactate 16 Quick notes: Ethylene glycol metabolites falsely register as lactate in most labs. Before the Osm gap math I’m thinking toxic alcohol and ethylene glycol.

#ALLNYCEM25 Dr. Brenna Farmer presents the case of the obtunded overdose round 2! This time we know it’s from Benadryl and get an EKG:

#ALLNYCEM25 Next case is a sick neonate! Entire room of 800 people groans. Come on, people- EM cares for 80% of acutely ill Peds. Not PEM, standard EM! But yes this kid is scary. BP 50/20 scary even for this young a kid. Think sepsis!! I mean we always do. What else?