Chika-what? The CDC recently sent out an alert (June 17th, 2014) to healthcare providers regarding the outbreak of the infection caused by the chikungunya virus in multiple Caribbean countries (http://wwwnc.cdc.gov/travel/notices/watch/chik…
A three month old male presents to the pediatric emergency department with his mother who reports patient has been constipated recently, his last bowel movement was five days ago. She reports he has also been had decreased appetite and PO…
A patient presents to you from a nursing home, with paperwork stating that her G tube fell out this morning as her nurse was attempting to give her her daily medications. What further information do you need to know, and how do you proceed…
A 33 year old male Riker’s inmate presents to the emergency department after corrections officers report that he was observed to have jumped off a chair in his cell, with a bed sheet tied around his neck. Per officers, they were able…
A mother runs into the pediatrics emergency department, clutching her 10 month old daughter. She states her daughter had been drinking from her bottle at home and then stopped drinking, turned purple, and became limp for ten seconds, and t…
As emergency physicians, we have all noticed that the number of geriatrics patients that visit the emergency department continues to increase over time. It is projected that by 2013, 20% of the population will be age 65 or older. One impo…
Your patient is a 35 year old male who presents with right hand laceration, he states he was reaching blindly into a drawer of utensils, and cut the volar aspect of digits 2-5. The laceration appears deep. How do you assess for liga…
A 30 month old female is brought to the emergency department by her 16 year old babysitter. Her babysitter states the patient was vomiting in the living room of her (the patient’s) home. When asked about her story further, she admit…
Peri-intubation oxygenation and maintenance of adequate alveolar saturation is vital to patient safety. Desaturation below 70% during intubation places patients at risk for hemodynamic decompensation, dysrhythmias, cerebral ischemia…
In patients with active or impending herniation and deterioration, 23.4% Normal Saline has been shown to be beneficial. It can only be administered through a central line. The current recommended dose is 30mL which must be given slowly over…
There was a study published on the Journal of Critical Care Medicine in July 2011 comparing US guided vs landmark approach to subclavian vein central line placement. In the study, “subclavian vein cannulation was achieved in 100% of…
In a patient w/ a trach who is now hypoxic and/or the trach is malfunctioning a bougie may potentially be passed through the trach directed cephalad, once the provider who is at the head and performing direct laryngoscopy is able to visuali…
After intubation, a quick and easy way to estimate ET tube position is by palpating the sternal notch and feeling for the ET cuff. By holding on to the pilot balloon (balloon used to check if cuff is inflated) and palpating on the sternal…
53 yo M w/ PMHx of HTN, CAD, and CHF s/p LVAD placement presents to the ED w/ c/o CP. Patient reports he had mild CP overnight but this morning woke up with increasing SOB and severe CP radiating to his R arm. He immediately called 911 an…
EMS calls in to the department and states they are en-route w/ an ETA of 5 minutes w/ an 8 yo M w/ no known PMHx in severe distress, no further history provided. 3 minutes later an 8 yo M is wheeled into the department by EMS, the child is…
