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Daily Pearl

A 45F with a PSH of silicone breast implants in ’99 comes in to the ED after slipping on some ice and falling onto her chest.  She is concerned that an implant broke and that she’ll “get blood poisoning or cancer” if the implant isn’t taken out right away.  What is the appropriate management ofRead more

Daily Pearl

Back to our patient from several days ago – 65M with HIV/AIDS, CD4 count 24, and prior CNS toxoplasmosis *compliant with his secondary prophylaxis treatment*, now BIBEMS for new AMS.  The head CT (WITH contrast) showed no new lesions, but the old lesions were larger with edema.  Is this definitely reactivation of Toxoplasmosis?    NO. Read more

Daily Pearl

Matt Bai decided to get his cat a turkey for Thanksgiving and went off to Central Park with a bow and arrows to find one.  Unfortunately he just winged the biggest turkey, and it attacked and bit him.  He came into the ED wondering if he should get a rabies shot.  What do you think?Read more

Daily Pearl

A 45M with no PMH is BIBEMS for AMS.  In the ED, he is obtunded with pinpoint pupils, respiratory depression, and an O2 sat of 90% on a NRB.  He does not respond to sternal rub.  His partner comes in and states that they were at a bar a few hours before, and the patient suddenly gotRead more

Daily Pearl

A 65M TCC resident with a PMH of HIV (CD4 count 24, VL 12K), cerebral toxoplasmosis in 2012, seizure disorder on keppra 1000mg BID, and endstage dementia was BIBEMS from TCC at noon for status epilepticus x 1.5 hours.  He had not had his antiepileptic meds changed recently, and he had had his morning keppra dose.  His last seizureRead more

Daily Pearl

A 4 year old boy is brought into the peds ED for 4 days of profuse vomiting.  The mother reports that he has vomited 10-15 times per day, at first stomach contents but by now empty retching.  No F/C, no diarrhea, no urinary symptoms.  In fact, he seems to be urinating more than usual.  HeRead more

Daily Pearl

You’re working in the resus room, and a code stroke is called in.  She arrives, and rather than any weakness, numbness, or facial droop, you see an elderly, unkempt woman who looks like she’s made of stone.  Her mouth is open and drooling, and she severe cogwheeling when you try to extend her arms.  She does not knowRead more

Qtips from Cqr

Elmhurst ER QTip: Once a study has been ordered, a multi-step process is initiated that may be difficult to interrupt. If, for example, a blood test is ordered but then deemed unnecessary, simply canceling the order in the physician order entry system is often inadequate to prevent that blood test from being run. In theseRead more

Daily Pearl 11/14

Three disorders of hair are shown in the images below. Identify each, and describe the pathophysiology & management. (A) (B) (C)      Read more

Daily Pearl 11/11

A 58 y/o M presents to the ED with altered mental status. He smells of alcohol, appears drunk, and has a longstanding history of alcohol abuse. You obtain a serum alcohol level of 100. Further laboratory work up shows a pH 7.28 with CO2 53, HCO3 25, lactate 3.5.   After an hour, he has 2Read more