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Clinical Pearl: June 29th

Interesting point from Amal Mattu. What historical factors of CP are predictive of ACS? 1) association with diaphoresis 2) association with vomiting 3) association with exertion 4) radiating to both arms or right arm   All others are not predictive,  including: sub-sternal pressure, lightheadedness, nausea, and dyspnea.   Sources: 1. Swap CJ, Nagurney JT. ValueRead more

Clinical Pearl: Thursday, June 28th

When assessing for a difficult airway what does the LEMON acronym remind us to check? In a study, only three factors from LEMON are associated with a difficult intubation, which are they?  Read more

Clinical Pearl: Tuesday, June 26

Thanks to Brittany for this excellent Peds pearl. A 4 year old boy presents with a fever and a one-day history of rapidly worsening limp at the LLE, now with complete refusal to bear weight or range the L hip. You are concerned about a wide differential, but particularly about septic arthritis. Labs are sentRead more

Clinical Pearl: Monday, June 25th

28F presents with two months of intermittent fevers and a new murmur.  You suspect infective endocarditis.   With this subacute presentation, how many blood cultures should you order? How far apart?  What empiric antibiotics are indicated?   What if the patient is unstable? how many blood cultures should you order? How far apart?  What empiric antibioticsRead more

Aneurysm screening

Sweep through large AAA from Sinai EM Ultrasound on Vimeo. Abdominal aortic aneurysm (AAA) affects 5-10% of males age 65-79, and among males over 55 years of age represents the 14th leading cause of death. Ruptured aortic aneurysm is associated with a very high mortality rate. Up to 80% of patients die by the timeRead more

Clinical Pearl: Friday, June 15

Thanks to A.Hill for today’s pearl: 19M presents with fever and rash on palms and soles x1 week. Vitals: Temp 101 HR 105 BP 130/80 RR 12 O2 100% What is the differential for rash on the palms and soles? Disseminated gonococcus Rocky mtn spotted fever Hand, foot, and mouth disease Secondary syphilis Kawasaki diseaseRead more

Clinical Pearl: Thursday, June 14

A patient presents after an episode of syncope vs seizure.   Can a serum prolactin level be helpful in differentiating the cause?Read more

Clinical Pearl: Tuesday, June 12

Thanks to PEM fellow Brittany for today’s cases. A 1 week old presents with cyanosis and sweating with feeds. No history of fever, preceding illness. O2 sat is 85%. Child is placed on 100% O2 but O2 sat does not improve. What are some possible causes of these symptoms?   What is your goal O2 sat for these patients?   What is the treatment?Read more

Clinical Pearl: Monday, June 11

23yo M presents with 2 days of substernal CP associated with fevers and dizziness, he called EMS for a near syncopal episode today. His triage vitals: Temp: 102.1  HR: 105 HR: 126/64 RR: 18 O2: 99% RA Exam: unremarkable exam: no murmurs/rubs, clear lungs, no rash, no signs of trauma. His EKG is below (clickRead more

Clinical Pearl: Friday, June 8th

A 20yo M is BIBEMS after falling from a scaffold at a construction site.  He has signs of head trauma. Upon arrival his VS are: T=98.9 HR=75 BP=185/90 RR=12 o2 Sat=99% on NRB His neuro exam: PERRL, moving all extremities eyes open to pain making incomprehensible sounds painful stimulation to the nail bed on the right handRead more