Answer: B. It is venous but extends to the right brachiocephalic vein. The central line is inadvertantly deep and likely resulted from the guidewire being displaced by the patient's PICC line. This patient will need the line removed/replaced.
Estimated Central Line Lengths for Correct Placement:
Right Internal Jugular Vein: 13 cm, +/- 2 cm
Right Subclavian Vein: 15 cm, +/- 2 cm
Left Internal Jugular Vein: 15 cm, +/- 2 cm
Left Subclavian Vein: 17 cm, +/- 2 cm
The acute medical management of an upper GI bleed from peptic ulcer bleeding includes both hallmark and emerging medical therapies with which any Emergency Physician should be intimately familiar. Many of these therapies are adopted recommendations from our Gastroenterology colleagues who ultimately perform emergent/non-emergent endoscopy on these patients. To understand why Gastroenterologists think the way they do, here is a review of these specific therapies along with the evidence behind them.
A high-yield review of the past week on EMDaily.
During a preseason exhibition game of this NFL season, Dallas Cowboys quarterback Tony Romo suffered a compression fracture of his lumbar spine against the Seattle Seahawks. While this was not a season-ending injury for Romo, the veteran quarterback lost his starting position to the exceptional play of rookie quarterback Dak Prescott during his absence. Also included in this post is key pearls about a Chance fracture, another important fracture of the thoracic/lumbar spine!
Happy Thanksgiving from EMDaily!
Case: An 8 year old girl presents to the Emergency Department with the feeling of shortness of breath. Onset was soon after a meal and her parents state that she may have choked on something.
How propranolol works to combat thyroid storm physiology, made simple.
The rare diagnosis of thyroid storm can be difficult to distinguish between thyrotoxicosis. Use the Burch-Wartofsky scoring system to help identify patients with thyroid storm! A score >45 is highly suggestive of thyroid storm.
A high-yield review of the past week on EMDaily.
There are an estimated 25 million golfers in the United States. Every time they step onto the course they spend hours walking in the sun and placing stress on their backs and nearly every joint in their bodies. It should be no surprise if one of these patients make their way into one of your Emergency Departments or Urgent Cares. Below are two of the most common golf injuries as well as pearls on how to prevent/treat them:
Low Back Pain/Strain:
