Clinical Pearl: July 24

A 14 year old male presents with gradual onset headache with blurry vision, photophobia, and right forearm “tingling.” He has had similar headaches previously, and this does not represent his worst headache. No neck stiffness. Comprehensive neuro exam is normal, visual acuity is 20/20 with no field deficits. No objective findings on physical exam. YouRead more

Clinical Pearl: July 23

Interesting couple of pearls today regarding adenosine boluses for treatment of SVT courtesy of Bryan Hayes (@PharmERToxGuy). Standard dose is 6mg followed by 12mg, except under certain circumstances: The ingestion of caffeine prior to an adenosine bolus significantly reduces its effectiveness in treating SVT. If your patient just finished a triple espresso a few hours ago,Read more

Clinical Pearl: July 20

A previously healthy young patient presents to the ED with sudden onset headache followed by progressive and profound altered mental status. You rush them to radiology for a head CT, which shows a large subarachnoid hemorrhage. Upon return from the CT scan, your nurse runs up to you with the patient’s EKG taken just beforeRead more

Clinical Pearl: July 19th

A 29 year old soccer player presents to your ER with a shoulder deformity after falling backwards onto an outstretched arm. He has dislocated the same shoulder three times previously. What two specific lesions should you look for on the xray? Why do they matter?  Read more

Clinical Pearl: July 17

An 11 day old infant presents to the ED with persistent emesis after every feed, along with progressive yellowing of skin since birth and a 30% weight loss since birth. Physical exam reveals normal vital signs and a jaundiced, slightly lethargic baby with notable hepatomegaly. Parents report that the baby’s newborn metabolic screening has notRead more

Clinical Pearl: July 13

A basic pearl for today : A quick review of hepatitis B serologic markers. In addition to the chart below, consider the hepatitis B e antigen (HBeAg), which is generally considered a marker of infectivity, as the protein is creating during the viral replication process. The presence of HBeAg is associated with high levels of HBVRead more

Clinical Pearl: July 12

A 55 year old male with ESRD on peritoneal dialysis (PD) presents with fever and abdominal pain, reporting cloudy-appearing effluent today from his PD port. You are concerned, appropriately, that the patient has peritonitis. Since the patient has a port leading directly to his peritoneum, could you just twist open the port, take a sampleRead more

Clinical Pearl: July 6

A 66 year old female patient presents to the ED with a transient episode of dizziness and SOB earlier today. PMH notable for stage III CKD, DM, HTN. She takes valsartan, metformin, and is currently on TMP-SMX (Bactrim) for a UTI. Her EKG shows NSR and laboratory studies reveal a confirmed K+ of 8.0 andRead more

Clinical Pearl: July 5

A 4 year old child presents to the ER with 7 days of a measured fever, along with a progressive diffuse red maculopapular rash over the trunk and extremities. On exam, the patient has a conjunctivitis and erythematous oral mucosa. What diagnosis should be high on your differential, and why is it important to treatRead more

Clinical Pearl: July 3

A 50 year old patient with HIV, HCV cirrhosis presents to the emergency room with subjective fevers and generalized abdominal pain with tenderness. As part of your workup, you plan for a diagnostic paracentesis. On ultrasound imaging, the patient has a large amount of easily tapped ascites. His INR, however, returns at 2.9. Should youRead more