Lacerations of the tongue often require special consideration considering the tongue's anatomic location and functional importance. Repair of tongue lacerations are often plagued by patient intolerance and inadequate anesthesia of the area.

Submitted by Joseph Cesarine, MD

Staying alert and functioning at a high level during an overnight shift in the Emergency Department is often a matter of life or death for your patients. Many of us employ the use of caffeine at all hours to combat the slow (sometimes rapid) creep of fatigue which hampers our skillset. Most providers can relate to those moments when a cup of coffee is just not what you are looking for. This post intends to introduce an alternative vehicle for caffeine designed for members of the military: Military Energy Gum. 

Submitted by Joseph Cesarine, MD

Your patient in the Emergency Department has a Zone II or Zone III finger amputation which requires primary closure of the wound prior to discharge with appropriate outpatient follow up. However, a protruding piece of bone often prevents closure of the skin flap and requires trimming by using a rongeur. While this process is typically carried out by an orthopedic or hand surgical consultant, this post aims to introduce the use of a ronguer during management of finger amputation in the Emergency Department.

Submitted by Joseph Cesarine, MD

Dynamic hyperinflation (autoPEEP, air trapping, etc.) is a process leading to an increase in end-expiratory lung volumes and increased airway pressures. This process may occur secondary to obstructive lung pathology and/or an increase in minute-ventilation without sufficient time for expiration. The pathologic effects of dynamic hyperinflation include an increased work-of-breathing, barotrauma, pneumothorax, and an increase in intrathoracic pressure leading to a decrease in cardiac output and possible hemodynamic collapse. Rapid identification of this process is crucial for reversing it.

Submitted by Joseph Cesarine, MD