Brachial veins

When assessing patients with difficult peripheral venous access it is often helpful to look in the medial upper arm. Here, the brachial artery (A) and veins (V) are predictably located between the biceps and brachialis muscles. The median n…

Tubo-ovarian Abscess

32F no PMH, p/w fever and abdominal pain x 5 days. Seen 5 days ago at OSH and treated for UTI w bactrim. Seen 2 days later, switched to doxycycline for presumed PID. GC/chlamydia negative.  Returns today w persistent pain and fever. Pain is…

Kanavel’s Sign

Kanavel’s sign: clinical sign found in patients with flexor tenosynovitis (infection of flexor tendon sheath of hand) –       involved digit kept in flexed position –       tenderness to palpation over tendor sheath –     …

Ultrasound Guided Lp

Ultrasound guided LP   Equipment needed: –       high-frequency (small parts linear probe) for patients with normal weight –       low-frequency 2-4 MHZ probe (abdominal curvilinear probe) for obese patients –       t…

Chlamydia Conjunctivitis in Newborn

10d male p/w R eye tearing and discharge x1 day. Today purulent. Born FT via NSVD, uncomplicated pregnancy and delivery. No fever. No vomiting, diarrhea. No URI. Taking good PO.  On exam, AFVSS, R eye diffuse soft tissue swelling, crusting…

Inferior Shoulder Dislocations

55 yo F presents with shoulder pain after fall from bicycle: Also known as “luxatio erecta”  – to place upward   Inferior shoulder Dislocation     Mechanism of injury: fall and sudden grasp of object above head resultin…

Eye Trauma & Bradycardia

A 3yo M comes into your ED around midnight after a fall off a stool onto his face. He has been vomiting, is bradycardic in triage to the 50s so is brought into your pediatric RESUS bay. Mom states that his eyes “look weird”. On…

Drowning Pearls

Thanks to our PEM fellow Dr. Michelle Vasquez for a great morning report today! Some questions that came up afterwards: Is there a difference in drowning with salt vs freshwater? -turns out that while there are blood and electrolyte shifts,…

Nailbed Lacs

A young man comes into your ED after slamming his right middle finger in the door. You see a large gash over the nail, and your hand specialist is not available to take care of the injury. What do you do?

My Face is Swollen!

A 15yo girl comes into your ED complaining of unilateral facial swelling that started this morning as a little bit of swelling under her R ear, and 8 hours later, is now her entire R cheek. No fevers/chills. ROS otherwise negative. VS norma…

Pediatric Fever & Rash

A 3yo M no sig PMH, IUTD, comes into your ED with complaint of 3 days of fevers, diffuse rash worst on the R hip, mild limp, N/V, no urine output today, and lethargy. On exam, found to be febrile to 40.1, tachy to 197, BP 90s/50s, sat 96%….

Talking About Goals of Care

Highlights from a rundown on end of life discussions in the ED taken from a lecture by Ashley Shreves: “…not all dying pt should have CPR. Some evaluation should be made before proceeding. The cardiac arrest should be sudden and…

Tall R in V1 Differential?

My CCU attending asked me to, if nothing else, remember 3 causes of a tall R wave in V1. In my diligence I have indeed remembered nothing else. What’s in your differential?  

Woke Up with Weak Legs

30 y.o. M PMHx hyperthyrodism, who presents c/o b/l leg weakness since this AM. Pt states he awoke with the symptoms and was unable to stand. Feels that his weakness is located in his thighs. Had similar episode 4 days ago, went to OSH and…

March 2015