Emergency physician, intensivist, and Mount Sinai Emergency Ultrasound Fellowship graduate Dr. Robert Arntfield is making news at his new home, London Health Sciences Center (LHSC) in Ontario, Canada. Dr. Arntfield and his department have s…
Today’s pearl is courtesy of the AM report. When evaluating the lethargic pediatric patient there’s lots to consider. Here’s a mnemonic, that if you can remember it (write it down) could be elucidating. Carbon monox…
A 55yoM is BIBEMS after an MVC c/o RLE pain w/obvious deformity at the thigh. Distally he is NVI but is in excruciating pain. The portable plain film shows a mid shaft fracture. You order dilaudid but he’s still really uncomfortable….
A pleasant 64yoM w/NIDDM and afib (on coumadin) p/w an abscess to R-medial thigh. He is afeb but there is some surrounding erythema at the abscess site. You perform a thorough incision and drainage and instruct him to return in 2days for wo…
A young woman is BIBEMS to your trauma bay. She has been assaulted, has multiple signs of trauma with a GCS of 6 and saliva is noted to be pooling in her mouth and onto the bed. After a swift and successful intubation you further assess the…
A young woman presents with a painful wrist, no trauma history. On exam, there is an effusion present, no erythema and tenderness to palpation. She is afebrile. How do you rule out a septic joint? What pathogen should be considered?
Although we tend to suspect torsion only in cases where there is ovarian enlargement, cyst, etc., there are a number of studies that show these are not reliable (sensitive or specific) indicators of torsion. Radiology reports often seem to…
An elderly person p/w R-knee pain after stepping off the curb a few days ago. There is mild swelling and the patient does not like to bear weight on the extremity. You order a plain film of the knee and it looks okay. When you present to y…
You are caring for a 7mo child who is not moving the LUE; a plain film shows a fracture. Child maltreatment is high on your differential. You want to order a skeletal survey and your medical student wants to know precisely what you’re…
A middle aged man presents complaining of foreign body sensation in his eye, subjective fever, pain with spontaneous eye opening and ipsilateral ear pain. On exam, you don’t see any foreign bodies, but you do note multiple corneal infiltrat…
28 y.o. male felt his left knee “pop” after landing from a jump while playing basketball. Knee exam revealed limited knee extension. X-ray is shown in the link below. Diagnosis? https://…
A 53yoM presents with bilateral TMJ dislocation which he has had in the past. He receives procedural sedation and multiple attempts at reduction using conventional methods with no success. What can be done now?
A 60yoM h/o A-Fib on Dabigatran, took his medication this morning and then slipped in the shower 10 mins later, hitting his head with +LOC. He did not want to come to the emergency room at first but approximately 14 hours later, complains o…
Inspired by Tali Porat’s M&M What is the most consistant ultrasound finding in an ovarian torsion? . . . Answer: Unilateral ovarian enlargement (>4cm). Up to 73% of these has a complex adnexal or pelvoabdominal mass, which can…
A 79yoM with history of CAD s/p PCI/CABG years ago, Parkinson Disease presents with chest pain. ECG is shown below. Your ECG machine is not malfunctioning, the tech has not made a mistake, and the patient is laying calmly (no shivering or t…