Fever in the Asplenic Patient Why we care Patient population Role of the spleen Top Infectious Ddx Management **The single most important thing you can do is obtain blood cultures and administer empiric IV antibiotics without any delay…
So you’re in peds and your patient is anemic. You need to transfuse, but you are confused. How much blood do you give? How fast do you give it? How much: The volume of blood to be transfused may vary depending on the clinical scenario…
There have been a few cases of supra-therapeutic INR in the Sinai ED recently, and at the request of one of our superstar interns, below you will find a brief set of recommendations regarding Supratherapeutic INR. The following bolded recom…
An HIV positive patient presents to the ED but doesn’t know his CD4 count. He hasn’t been taking his HAART and you’re rightfully concerned that he might be susceptible to opportunistic infections. Unfortunately, you can…
Lets be honest: whether you like it or not, it’s a rare day working in the ED when you don’t guaiac someone. To “guaiac them” is of course slang for performing a point of care fecal occult blood test. Its a valuable tool and can…
A young lad with acute lymphocytic leukemia (ALL) shows up to your ED feeling very weak and c/o sever muscle cramps. On further questioning he reveals that he started chemotherapy 3 days ago. Labs show potassium of 6.5 mEq/L, calcium of 6.3…
Your patient is a 50 year old male who presents with head trauma. He takes aspirin daily. Neuroimaging demonstrates subdural and subarachnoid hemorrhage. You plan to treat with DDAVP and platelet transfusion. When ordering the platele…
You’re on your last patient of the day, starting to thinking about which type of sushi you’re going to order later, when the ultrasound comes back. Positive study, you were sure of it, after all, the patient had a hx of cancer a…
CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopa…
An 8 year old female is brought in by her mother after falling off her scooter one hour ago. She was not wearing a helmet, and hit her head on the ground. Patient and mother deny LOC. On exam, she is well-appearing, playing with her mother…
Here are some Heme questions for your holiday weekend. Enjoy! 1. A 9-year-old female with mild type I von Willebrand’s disease presents with mild gingival bleeding after her first overly vigorous attempt to use dental floss. She stopp…
A 25 yo male with no PMH walks into your ED complaining of right neck pain, right shoulder stiffness, and cough x 1 month, no fevers chills. On exam his vitals are all within normal limits, exam is notable for right sided swelling and asym…
26 M pmh sickle cell disease p/w chest pain, sob, fever, and cough. She is noted to be hypoxic, anemic and has new pulmonary infiltrates on cxr. What diagnosis must be considered? A: Acute chest syndrome “Acute chest syndrome i…
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 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…
