ACEP Day 1, Lessons Learned

Lots of good lectures on day one, and here’s a partial list of ‘things I learned’ today:

  • a better way to make a splint for 2nd and 3rd metacarpal fractures
  • a better way to make a splint for a distal radius fracture
  • nebulized Lidocaine can help for coughing in COPD (and there’s one study saying it helped get people off long-term inhaled steroids)
  • there’s a deep brachial vein just medial to the brachial artery just above the elbow: it can be accessed by a blind stick, but sono is better, and it’ll need a 2" catheter
  • Putting a finger in the supraclavicular fossae while threading the guidewire in subclavian line placement cut the number of mis-placed lines to zero in one (small) study
  • As for Chest Pain, "Atypical is Typical"
  • a proposed reason for the drop in meth lab seizures in the southwestern US: Tijuana pharmacies bought more pseudoephedrine than all the US pharmacies put together last year (see also: globalization, outsourcing)
  • suspect ethylene glycol poisoning and looking for flourescin with a woods’ lamp?  Look on the face (splashes while drinking) along with the urine
  • CT angio is now better than formal pulmonary angiography 
  • Methadone can cause adrenal insufficiency
  • And, for the quote of the day: "You’re not that smart in the ED, and it’s OK: Intelligence in the hospital is Altitudinally based"

Good meeting so far, and nice to see an old friend here. 

We went out on the town, had some fun, and made sure to leave enough money behind so they can leave the lights on. 

Day 2 looks good, too! 


  1. The new ACLS standards indicate that IO access is faster, cheaper, easier and indicated before central lines.
    We’re testing the EZ IO (drill) and it sure seems like a great tool. It’s easy, very precise, and is a rock-steady anchor.

  2. “altitudinally based”! That’s funny!

  3. I’d not heard about using a woods lamp to look for the fluorescein in antifreeze (as a surrogate for ethylene glycol). That’s terrific! (The ethylene glycol test takes days to come back.)

    What is the reference to CT angio vs. pulmonary angiogram? And what was used as the “gold standard?”

  4. Can Methadone cause adrenal insufficiency in neonates whose moms are on Methadone maintenance or did the study not address that? Has it been published yet so I can go hunt it down?