Intermittent Visual Symptoms

57 yo M with PMHx of uncontrolled DM and HTN who presents with 3 weeks of intermittent  visual problems. Patient reports he sees flashes on both left sides of visual fields in both eyes. He is also unable to process 3D spacing and has troub…

Sepsis and Ppm Failure

85 yo M with PMHx of CHF, paroxysmal atrial fibrillation and dual chamber PPM placed for sick sinus syndrome, who presents with lightheadedness, confusion and progressive lethargy x 1 day. At arrival to the ED patient hypotensive 70/30, bra…

Twisted Ankle

A 32 yo M presents with ankle pain and swelling after forcefully externally rotating it while playing soccer. He is unable to ambulate.  Ankle x ray is shown below. What other joint should you image?

Pearls for Meningitis

1. In a patient with suspected meningitis, should you give dexamethasone? 2. In the same patient, how much time do you have after giving empiric antibiotics to perform your LP?

Cqr Q-tips September

Clinical Quality Review topics for September 2014 -After ruling out ectopic, involve OB in patients with 2nd trimester miscarriage (these patient are more likely to need an intervention/procedure), or in unwell patients with 1st trimester m…

It’s Stormy

28 you F with no known PMH, p/w palpitations x 3 days after bus trip to Washington DC, states she is feeling “awful”, symptoms have been constant and worsened today.  Also endorses b/l LE swelling, nausea, vomiting x1 per day, f…

October 2014