EM:RAP

What is your comfort level with using ultrasound for an eye exam? If it could be better, we have a new video for you.
A practical guide to safe, clear ocular scanning, covering setup, probe handling, and how to confidently differentiate high-yield pathology. Learn how to optimize images without applying pressure and how to use the optic nerve sheath to support intracranial pressure assessment.

Key Reminders: Use generous gel, measure the optic nerve sheath diameter at the correct depth, and know the key visual cues separating retinal detachment, vitreous hemorrhage, and posterior vitreous detachment.

Can you facilitate a caring end-of-life process in the emergency department?
Mizuho and Bob Uslander, MD present an important 2-part segment this week. The discussion runs through the differences between palliative and hospice care, medical aid in dying (MAID), non-traditional end-of-life care, voluntarily stopping eating and drinking (VSED), and the important topic of palliative sedation. We all would like to be better prepared to treat these patients and their families, and the path to that is education. Listen to the entire segment this week on EM:RAP for a fuller picture of this important topic.

🫁 Driving Pressure = Plateau Pressure − PEEP. Keeping this value below 13–15 mmHg may help reduce ventilator-induced lung injury. Learn how to recognize high driving pressures and the early vent adjustments that can help.

Does your system have the ability to use heparin in the pre-hospital setting for patients with STEMI? We all know the positive benefits of heparin early in the ED for STEMI patients, but is there utility in providing it even earlier? Comment below your thoughts, and make sure to listen to the entire segment. It’s FREE on the EM:RAP app.

In the HEPARIN STEMI trial the authors try to push the initiation of heparin for STEMI patients into the pre-hospital setting, and although their primary endpoint of good flow in the culprit artery at the time of initial cath did favor the intervention group, this did not translate to differences in post-procedural TIMI 3 flow (81% vs 81%), 30-day mortality, or cardiogenic shock, leaving the clinical significance of the early IRA patency benefit inferential at best. Until harder clinical outcomes are demonstrated in more generalizable populations, this trial best supports what many already practice — early heparin in STEMI — while raising the possibility that the timing of administration may matter more than previously appreciated.

*NEW* Ebola Chapter!
Are you up to date with the latest Ebola outbreak? Check out our new chapter!

On May 5, 2026, the World Health Organization was notified of an outbreak of an unknown, high-mortality illness in Ituri Province, Democratic Republic of the Congo, including deaths among healthcare workers. Laboratory testing by the Institut National de Recherche Biomédicale confirmed Bundibugyo virus disease, caused by a species of ebolavirus, in 8 of 13 blood samples on May 15, 2026. Previous Bundibugyo virus disease outbreaks have had case-fatality rates of approximately 30% to 50%. For Bundibugyo virus, unlike Zaire Ebola virus disease, no licensed vaccine or specific antiviral therapy is currently available; therefore, early supportive care is critical for improving survival. Other available vaccines are not effective against Bundibugyo virus.

For more on the identification and treatment of this disease, as well as isolation precautions, please check out our updated Ebola chapter in CorePendium. LINK IN BIO.

Can you tell the difference between a tracheostomy and a laryngectomy? 🤔

Recognition of tracheostomies versus laryngectomies is a life-saving skill. Remember, laryngectomy patients can only be oxygenated and ventilated at their stoma.

Jess and Laura Bontempo explain why identifying the type of “neck hole” is a life-saving skill. They provide rapid visual clues and specific ventilation techniques for patients with tracheostomies and laryngectomies. This is your top-to-bottom review of anatomy, identification, diagnosis and emergency management. A pearl-filled segment that is a must-listen 🎧

Check it out today in the EM:RAP app 📲

A focused tip on the trickiest part of eye irrigation: how to smoothly insert Morgan lenses by starting with the lower lid first, after proper anesthetic application.