My Head Hurts

35 y F presents to ED with sudden onset worst headache of life starting 3 hours ago.  Refractory to treatment with excedrin.  No history of Migraines.  Concern for SAH. What is your management algorithm to rule out SAH?  Do you CT/LP?

Orthopedic Injuries

34 y M with right midfoot swelling and pain after injuring while playing football.  The patient describes a hyper-plantarflexion mechanism.  Physical exam notable for bruising to medial plantar foot and diffuse swelling to dorsal midfoot wi…

Exertional Syncope

23 y M presenting to ED with episode of syncope while playing soccer this afternoon.  Endorses preceding palpitations, but denies any associated CP/diaphoresis/n/v/sob.  EKG is as follows: What is the diagnosis?

Post Cardiac Arrest Care

According to the American College of Cardiology(ACC), based on guidelines published this month, there is a shift in the post cardiac arrest care algorithm.  The prior guidelines from 2013 have a Class I recommendation for performing immedia…

I’ve Got a Lump

45 y  male with no known medical problems presents to the emergency department complaining of tender lump to left axillary region worsening over the last 2 days.  Pt notes that over the last 3 days he had also been having subjective fevers,…

Do Less

A 4 y female arrives to ED accompanied by mother after witnessed mechanical fall off out of stroller (approximately 3.5 feet high) with head hitting linoleum floor.  Mom states that the child cried immediately afterwards and never experienc…

Respiratory Failure

As we all know, NiPPV is a well established practice and therapy of choice in patients with COPD and CHF exacerbations.  It is typically used in patients with hypercarbic respiratory failure.  But for those patients who come to the ED with…

I Think I Ate Something Fishy

31 y M presents with n/v/d and altered sensation to hands and feet several hours after going out for a seafood dinner.  Pt states that he ate red snapper at the request of a work colleague and prior to tonight was in his USOH.  Later, durin…

Sob in Heart Failure

A 64 yo male with a history of CHF and COPD arrives with a complaint of acute onset SOB since this morning.  Lung exam is notable for diffuse Rhonchi.  You believe the patient is having a CHF exacerbation, but you’re also concerned fo…

Ekg Fun

54 y M presents to the ED with complaints of chest pain starting acutely 4 hours ago.  The EKG is as follows: What’s the diagnosis? 

Pediatric Wheezing

21 month old male with wheezing and cough for 6 hours.  Otherwise in usual state of health prior to lunch this afternoon.  No history of reactive airway disease.     What is the diagnosis?

Apneic Oxygenation

You are a first day intern (literally, for many of you), the cardiac room is overflowing with patients and you are asked to set up for endotracheal intubation on a patient with declining mental status.  You haven’t intubated since you…

Cta Vs. V/q Scan in the Pregnant Patient

A 25 y F g1p0 @8wks pregnant presents to ED complaining of SOB. Clinical suspicion for PE with a positive dimer to 0.68.  Assuming lower extremity dopplers and chest x ray are unremarkable. How will you further workup this patient? CTA or V…

July 2015