A 75M presents with several days of cough, fever, and progressive lethargy. CXR demonstrates RLL pneumonia. BP 70/50. HR 130. Lactate 5. T38.0 2L bolus NS given. Antibiotics started. Bedside sono shows noncollapsing IVC, hyperdynamic LV. Re…
Pt is 54 yo M with PMH of DM, HTN, Crohn Disease presents with 2 days of worsening vomiting, had diarrhea initially that has now stopped and is no longer passing gas, also reports some slight abdominal distention. Patient has had several ab…
Patient is 49 yo F who presents to ED with few days of fever (T max 102F), progressive headache, neck stiffness. Patient denies any travel, rashes, sick contacts. Pt complains she can’t be in a well lit room or go outside without pain…
“Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients wit Allergic Reactions or Anaphylaxis” Grunau BE, Li J, Yi TW, et al. Annals of Emergency Medicine 2014; 63(6): 736-744 Background: Al…
Appendicitis on ultrasound – the first step is to identify the appendix by finding a blind-ending tubular structure arising from the base of the cecum. The sonographic signs of appendicitis include: dilated…
Quantitative D-dimer is a common screening tool to rule-out pulmonary embolism in low-risk population but is there more that it can tell us? Yes, there have been studies linking increasing d-dimers to: 1) likelihood of PE, 2) locatio…
Tenosynovitis = inflammation of a tendon and its sheath. Most acute cases of flexor tenosynovitis (FT) are infectious but may also be secondary to inflammation from noninfectious cause (e.g. diabetes, overuse, arthritis) Infectious tenosyn…
Early death (within 7-30 days) in PE patients is concerning. It is relatively easy to identify high-risk PE patients, defined by abnormal vitals SBP < 90 or drop in SBP by 40 for at least 5 min. Normotensive patients with poor prognostic…
A 24 year old female from Europe presents with progressive shortness of breath and hemoptysis. O2 sat is 94%. CXR is clear. PSH includes silicone implants in gluteal area. Meds include OCPs. Travel from Eastern Europe 2 months ago. D-dimer…
This week, PECARN published a study that determined that isolated loss of consciousness (LOC) is not a strong enough predictive factor for a clinically significant traumatic brain injury, which they define as requiring intubation, extended…
A 45 year old male comes in with swelling of the tongue, fever to 102F, and O2 sat of 92% at triage. Patient states he has been having dental pain for the past two days.
4 teasers for the 4th of July weekend. 1. What is this and why is it dangerous? 2. Patient had a DVT + PE, then got an IVC filter, then had another PE. How? 3. Fun Sporcle quiz – 3 letter body parts, 2 min 4. Higher level Sporcle quiz…
Let’s learn more about POCT pregnancy tests… At our institution, we use a POCT pregnancy test using urine. This is an immunochemical test that can additionally be used by serum to detect pregnancy. In order to obtain accurate…
A 36 year old male with no past medical history presents reporting two weeks of worsening penile pain and notes pain when retracting his foreskin. Vital signs are within normal limits. Without giving the answer away with the patient’…
A nurse from triage presents a case to you of a 43 year old woman that he believes is having an allergic reaction. When you evaluate the pain, you notice her skin is bright red from her face to her ankles. She denies any pruritis, and you…
