Blog

An unusual rash

A 19 yr old male with a history of depression presents to the ED with diffuse, worsening rash, arthralgias and fever for the past 2 days. The patient recently started taking bupropion over the past 3 weeks and also started venlafaxine last week. He notes that the rash began as pruritic hives over his bodyRead more

RESUSCITATE NYC 2016 – Report

Resuscitate NYC 2016 was amazing. Special thanks to Scott Weingart (@emcrit) and Felipe Teran (@FTeranmd) who made it all possible! Get an inside look at how it all happened. Attendees:  540 EM Residents 50 Faculty from EM and CC 50 EMS, RNs, PAs Speakers:  14 Speakers 10-15 Minute talks 8 Medical Centers Represented Twitter #resusNYC16: Read more

Emergencies in Patients with Rheumatologic Disorders

Patients with connective tissue diseases and vasculitides can present to the ED with vague or seemingly innocuous complaints but may actually have a life threatening condition. Key conditions to assess for include: 1. Septic arthritis in the rheumatoid arthritis (RA) patient Can be difficult to diagnose, especially in the earlier stages of infection, where anRead more

Liver Disease and Intracranial Hemorrhage

Liver cirrhosis is associated with hematologic derangements which can cause both coagulopathic and prothrombic states. However, it is less clear whether liver disease truly increases patients’ risk for intracranial hemorrhage (ICH). A recent large retrospective cohort study found a modestly increased risk of ICH in patients with liver disease. Further prospective studies may help confirmRead more

ED Management of Drowning Victims

Drowning is defined as “the process of experiencing respiratory impairment due to submersion/immersion in a liquid.”   Pathophysiology: Drowning occurs as the patient’s airway is submerged below water. Initially, the patient will try to hold his/her breath for approx. 1 minute, followed by involuntary inspiration and subsequent introduction of water into the airway. If submersionRead more

Causes of sudden cardiac death in the young?

Hypertrophic cardiomyopathy Genetic condition usually due to mutations in one of several sarcomere genes causing LVH and potentially LV outflow obstruction, diastolic dysfunction, mitral regurgitation. Patients may present with CP, dyspnea, palpitations, syncope, or SCD (from sustained ventricular arrhythmias). EKG often shows LVH, but can also show abnormal Q waves or P wave abnormalities (LARead more

ED-initiated palliative care consultation improves quality of life in advanced cancer patients

A single-blind, randomized clinical trial of ED-initiated palliative care consultation for patients with advanced cancer showed a significant improvement in quality of life as measured by a change in the FACT-G score at 12 weeks. Median survival was also nearly 5 months longer in the intervention group but this was not found to be statisticallyRead more

Best approach for pericardiocentesis?

Both subxiphoid and parasternal approaches have been used for emergent pericardiocentesis in patients presenting with pericardial effusion and tamponade, but which approach minimizes procedural complications? In a 2012 review by Clinical Anatomy, when using ultrasound guidance, a parasternal approach was found to be generally more effective and safer than a subxiphoid approach.   A subxiphoidRead more

LAST

40 yo F, no PMHx, brought to ED for acute onset of shortness of breath, nausea, and vomiting. She was undergoing hair transplantation for traction alopecia at an outpatient surgi-center. BP 79/40, satting 75% on RA. Bedside sono shows you a grossly reduced EF with poor myocardial contractility. What is happening to her? What isRead more

Hydrofluoric Acid Burn

A young man who works in a glass etching factory is rushed to ED for severe pain to his hand after a high concentration chemical solution spilled onto it. He complains of severe pain to the hand in the area of his injury, diffuse abdominal pain and intermittent twitching of several different muscles. On exam there is destructionRead more