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 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:
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…
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.
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…
The loop technique involves making two incisions at either pole of a skin abscess to initially drain its purulent contents. A loop drain is then inserted into one incision site and out the other, tied off above the skin with some movement o…
The two-point compression ultrasound exam assesses the lower extremity venous system at two points: common femoral vein and popliteal vein. Signs of DVT include lack of compressibility and visualized thrombus. [1]
Diagnostic abdominal paracenteses are frequently performed in the ED for patients with known liver disease. What complications can occur? What if the INR is elevated, as in many patients with liver disease?
A 40 y/o G10P10 presents with RUQ pain worse with fatty foods. When evaluating for acute cholecystitis, what 5 sonographic findings do you look for? What is the Mickey Mouse sign? What is the mantle clock sign?
An 80-year-old male is brought by family for AMS. On initial assessment: BP 86/45, HR 160s, in AFib, tachypneic. While addressing the ABCs, you’re also wondering what diagnostics can be performed immediately to help evaluate this undifferen…
A recently published retrospective study in the Annals of EM supports the use of an age-adjusted d-dimer cutoff when evaluating patients with possible PE. Standard cutoff = 500 ng/dL; Age-adjusted cutoff = patient’s age x 10 Click for more…
You are setting up for procedural sedation and would like to use propofol. What allergies should you ask of first? (Besides prior propofol allergy) [1]
[1] Your fellow resident just returned from a long lunch break, raving about how good his meal was. He doesn’t seem to notice, but his breathing is labored and his face and arms are covered in an urticarial rash. What is the most likely con…
Case: 32-year-old male brought in by EMS for altered mental status, breathing six breaths per minute. You suspect opioid overdose, what clues you in to the culprit? 1) ECG shows prolonged QTC –> 2) ECG shows widened QRS –>…
What are some special considerations when placing a central line in a patient with an AICD?
