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Heme Questions

Here are some Heme questions for your holiday weekend. Enjoy! 1. A 9-year-old female with mild type I von Willebrand’s disease presents with mild gingival bleeding after her first overly vigorous attempt to use dental floss. She stopped as soon as she noticed bleeding, which is limited to the space between her upper central incisors.Read more

Pearl for 12/21

A 25 yo male with no PMH walks into your ED complaining of right neck pain, right shoulder stiffness,  and cough x 1 month, no fevers chills. On exam his vitals are all within normal limits, exam is notable for right sided swelling and asymmetric neck. CXR as below:       What are youRead more

Make Up Pearl

1. As a follow up to Raashee’s expertly presented Wide Complex Tachycardia Talk, here are 2 questions:   SVT with RBBB or VT?  Read more

Derm Pearl

A 36 year old male presents to your resus bay complaining of allergic reaction, took first dose of Bactrim last night, started having pruritis, chills, body aches last night and now entire face, chest and back are erythematous and warm. No respiratory symptoms. Exam is notable for tachycardia, blanching diffuse erythema to face, chest andRead more

Pearl 12/17

Thanks to Dr. Glassberg for this case: A middle aged patient with pmh of htn, remote cva with minimal left sided deficits is brought in by wife after fall while intoxicated. Wife is concerned because patient falls frequently x years but now is falling daily, seems withdrawn/angry and barely eats. Patient admits to being a dailyRead more

Lung Ultrasound Pitfalls

Thoracic sonography is one of the most rapidly growing areas of emergency and critical care ultrasound. One very important emerging indication is to assess for lung consolidation. The characteristic appearance of consolidated lung is very sensitive and specific for pneumonia, but novices should heed some important pitfalls in making the diagnosis. Special thanks to JimRead more

Td, Tdap, Dt, Dpt, Dtap???

My patient needs a tetanus shot — what kind do I give??Read more

Headache

70yoM with headache and R temporal artery tenderness.Read more

Papilledema and the Crescent Sign

  What’s abnormal in this image?   Here’s a hint.  Here is an example of normal.   When evaluating for possible elevation in intracranial pressure, it has been shown that optic nerve sheath diameter (ONSD) measurements correlate with elevated intracranial pressures.(1,2)  The optic nerve attaches to the globe posteriorly and is wrapped in a sheath thatRead more

Jim Tsung publishes groundbreaking pneumonia POCUS study.

It truly is the year of ultrasound — and it isn’t even 2013 yet.  Groundbreaking article on lung ultrasound by our Jim Tsung who found point of care ultrasound to be 86% sensitive and 89% specific in detecting pneumonia up to age 21.  ePub is available ahead of print in JAMA’s Archives of Pediatric and AdolescentRead more