Daily Pearl

A 24 year old man was a direct admission from his PMD for evaluation of “palpitations.”  In ED,  the patient is reporting worsening palpitations and shortness of breath. • PMHx: Denies • Meds: None • Allergies: PCN – rash EKG   What is the Rhythm? What is the potential treatment?Read more

Daily Pearl 2/18

25 yo F recent UTI on Bactrim presents to PMD with dyspnea this AM. Transferred to ED for further eval after having been found to have O2 saturation 89% on RA. On arrival, patient is overall well appearing. Breathing at 16, comfortable. No focal findings on exam. Lungs CTA. No clinical evidence of DVT. PMHRead more

Daily Pearl 2/14

56 yo M PMH of cirrhosis comes in with upper GI bleed x 2 days. Initially with mild coffee ground emesis x 3 yesterday. Today, with 10 episodes of frank hematemesis. VS HR 144 BP 60/30 T 99.6 RR 22 O2 sat 96%. Massive transfusion protocol activated. Level 1 Rapid transfuser at bedside. What areRead more

Daily Pearl 2/12

55 yo M PMH hepatitis B and associated cirrhosis presents with 2 days of worsening AMS and abdominal pain.  Abdomen distended and exquisitely tender. Diagnostic paracentesis performed. Abx started. Resident has syringe with 60 ml of ascites fluid. What tubes does the resident need? What is a safe method for fluid transfer?Read more

Daily Pearl 2/11

59 yo M PMH a fib presents with 3 hours of palpitations found to be in A fib with RVR to HR 150-160. Two similar prior episodes in past. Treated with cardioversion. Baseline typically in sinus rhythm. CHAD2 score=0. Not on anticoagulation or rate control medication at home. Decision made to cardiovert the patient. PatientRead more

The Ectopic Brain

Apps that make your EM life easier   1. How can I keep notes/articles/links/logins with me at all times? -download app Evernote (download to your phone and to you computer) -start with a shared notebook, PV cards from Michelle Lin 2. How about that crashing pediatric patient, what dosage of succinylcholine should I use? -downloadRead more

Tachycardia After Sedation

60F with a history of Hepatitis C cirrhosis presents to the ED with acute onset of hematemesis. She is treated immediately with two large bore IVs and her airway is successfully secured with RSI, using Ketamine and Rocuronium. She is treated initially with Protonix and Octreotide as per gastroenterology’s recommendations. She is given Ceftriaxone empiricallyRead more

Not Your Usual Obstruction

8 year old male who recently immigrated from Thailand presents to the emergency department with bowel distension, constipation, and non-bloody vomiting. His mother notes that one week prior the patient had non-bloody diarrhea associated with diffuse abdominal pain. The patient has had recurrent diarrhea for several months associated with a mild cough. The mother statesRead more

Interesting Therapy

33M with no PMH presented to the ED with one day of palpitations, complicated by a week of nausea, non-bloody non-bilious emesis, generalized weakness. On physical exam, the patient is diaphoretic, tachycardic with atrial flutter to 140s,  febrile to 103F, initially AO x3, but now becoming drowsy and fatigued. The patient denies headache, neck stiffness,Read more