Sometimes the most serious oncologic emergencies present very benignly: a slow nose bleed (portending DIC), a low grade fever (neutropenic bacteremia), vague weakness/fatigue (an undiagnosed leukemia)… The triage nurse calls you out to triage to evaluate a patient as the resus resident. He is concerned because the patient is complaining of “I can’t walk straight,”Read more


32-year-old, “otherwise healthy,” man with severe, sharp, epigastric abdominal pain. Your differential is broad enough, but you target a few questions: Drinker? (No.) Gastritis/GERD/PUD in the past? (No.) Gallstones? (No.) Smoker/Hypertensive/your-aorta-or-mesenterics-are-in-trouble? (No.) Bitten by a scorpion lately? (No.) Jokes aside, you’re thorough. He has had terrible, worsening, constant pain for the last 2-3 days. NoRead more


It’s summer. Drowning is a tragedy that kills about half-million people each year worldwide, and is the second leading cause of traumatic death among children age 1 to 4 in the United States. Death from drowning (i.e. respiratory failure secondary to submersion/immersion in a liquid) occurs acutely secondary to hypoxia, laryngospasm, and aspiration. If survivingRead more

Slant-back Ingrown Toenail Repair

An intake / peds / fast-track chief complaint with an almost certain procedure: ingrown toenail. To state what may be obvious, this occurs when the distal portion of the nail has improperly grown into the lateral nail folds. It causes inflammation, pain, and often a paronychia, too. It can be caused by poorly fitting (tight) shoes,Read more

START Triage

As promised, another EMS-related post. Imagine yourself the first to arrive on the scene of a bus accident when you’re driving on your next road-trip vacation. Patients (limp, crawling, walking) are strewn about the street next to the over-turned vehicle, and you can see another dozen or so more people inside–some moving, some screaming, othersRead more


Surgical resident X: “We have to get the chest X-ray before we go to CT.” EM resident Y: “Honestly, [surgical colleague X], I don’t think we do. The FAST didn’t have any evidence of pneumothorax, so I think we’re safe to proceed to the CT scanner rather than wait for X-ray right now.” Surgical residentRead more

CRASH2 and TXA in Trauma

The use of Transexamic (spell that 10 times fast) Acid, or TXA, in trauma is largely based on the CRASH2 trial. This was a large, multi-center, randomized controlled trial with over 20,000 patients that demonstrated a mortality benefit of TXA for trauma patients when initiated within 3 hours of the injury. The NNT is 68, with anRead more

Antibiotics in COPD Exacerbation

The term “COPD Exacerbation” is itself kind of ambiguous, but most definitions overlap with a patient carrying a chronic obstructive disease diagnosis presenting with increased sputum or cough, or increased shortness of breath reasonably above baseline. The benefit of a minimum-five-day course of antibiotics (azithromycin in most cases, though the benefit was seen no matterRead more

13 Dangerous Headaches

After spending 15 minutes or so reading through Reuben Strayer‘s how-to-present-to-him-as-a-med-student document (a systematic approach to the patient’s complaint, social situation, available resources, and physical exam), I went to see my first patient: a young woman with a headache. I don’t remember many of the details now–it struck me as a benign problem at theRead more

1.7 million

FDNY EMS responded to over 1.7 million “jobs” in 2017, according to the FDNY annual report, with an average response time of less than 7 minutes to life-threatening emergency calls. You’re an ER doctor in New York City. Time to learn/reinforce some of the most common terms you may hear thrown around! Want to learnRead more