Subarachnoid Hemorrhage Revisited

Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency…

Choosing the Best Test

Today’s pearl is short and sweet. Here’s a breakdown of common radiologic studies performed in the emergency department along with their sensitivities and specificities according to the available literature. You may be surprised by so…

To Buffer an Acid You Add a Base, Right?

What do you do if your septic patient now has a lactate of 12 and a pH of 7.00? You’ve already started your fluids, antibiotics, pressors, and have ruled out any unaddressed source. Intuitively, your patient’s acidosis should be corrected b…

A Modified Valsalva for Svt

Although clinical practice may differ, vagal maneuvers are still the first step in attempting to convert supraventricular tachycardia (SVT) to sinus rhythm prior to adenosine. The reason why they are rarely attempted is because of relativel…

Arytenoid Cartilage Dislocation

Your patient with respiratory failure was successfully intubated and admitted to the MICU. Two weeks later he comes back to the ED complaining of persistent hoarse voice and dysphagia. He states he was extubated 1 week prior and was told hi…

Serum Sickness

Serum sickness is an often overlooked entity when considering the differential diagnosis of a febrile patient. This is a brief overview on the history and management of a patient who presents with signs and symptoms of this disorder:

We’ve Got a Pumper Here!

Hemostasis is an essential step in wound management. Most commonly, bleeding is caused by lacerated subdermal plexus and superficial veins which can be controlled with pressure alone. When lacerations are especially deep, an artery may also…

Cardiac Tamponade

Cardiac tamponade is a condition in which there is life threatening compression of the heart as a result of external pressure from the presence of fluid, gas, pus, clots, or blood in the pericardial space.

Abdominal Pressure Measurement

Abdominal compartment syndrome (ACS) is a condition in which the internal pressure of the abdomen becomes so great that it compromises venous return (and therefore hypotension), organ perfusion, and adequate ventilation.

Doc, I’m Feeling Lightheaded…

A 43-year-old patient arrives to the ED complaining of palpitations. Vitals are HR 298, BP 107/74, SpO2 100% RA, RR 18. The patient is diaphoretic, uncomfortable appearing, and heart sounds are fast and irregular. You obtain an EKG which sh…

July 2024