Asking an anesthesiologist or EM doc their choice of paralytic can spark heated debate. What do you prefer? Succinylcholine: -depolarizing agent -30-60 sec onset -8-15 min duration -adverse reactions: bradycardia, hyperK, fasciculations, m…
You’re rotating in the RICU and while there one of your patients develops respiratory distress requiring intubation. As you are preparing your equipment you notice that the intern on the team, who is trying to be helpful, is holding t…
This recent meta-analysis in the BMJ found that paracetamol (acetaminophen) was no better than placebo for the treatment of low back pain.
32 yo overweight female presents with a headache. This headache is similar to prior headaches, which she gets frequently. The rest of her story seems consistent with a migraine and her physical exam, including a through neuro exam, is nor…
47 y/o female PMH appendectomy presents with three days of worsening abdominal pain and constipation. Over the past day she has had persistent vomiting. She appears ill and has a diffusely tender abdomen. You quickly order labs and an obstr…
You are on your PEM shift overnight when a 9 year old boy with history of behavior disorder, BIBEMS only moments (<30min) after witnessed ingestion of 500mg of his grandmother’s amitriptyline. On arrival, ABC’s intact, and the patient is…
A 19-year-old-male with no known past medical history, presents in progressive respiratory distress shortly after undergoing a tooth extraction about 6 hours prior to presentation. Symptoms began initially as “a lump in his throat” and diff…
44 yo F with h/o ESRD on HD and neurosarcoidosis complicated by panhypopituitarism on chronic steroids and thyroid replacement, BIBEMS obtunded. Last seen normal a few hours ago. The patient is hypotensive SBP ~75 and FSBG is undetectably l…
54 yo F with no PMHx, but admittedly has not been seen by an MD in many years, presents after her daughter visited from our-of-town and found her slightly confused. The patient is disoriented, but able to provide some history. She describes…
56 yo F with no PMHX, presents complaining of increased DOE and orthopnea for several weeks. She also reports intermittent, mild mucosal bleeding. She denies syncope. Physical exam is notable for an obvious crescendo- decrescendo murmur ove…
You are fed up with the big city, so you decide to take a job as an ‘island doc’ in the Caribbean. Life is good. It’s your second day on the job, and an 18 year old man is carried into your clinic with severe knee pain and…
A 30 year old male presents to your ED, complaining of wrist pain following a fall while playing roller hockey. He denies wearing protective gear. On exam he has point tenderness over the dorsal aspect of his R wrist. You order an plain fil…
32 year old male with history of HTN, presents to your ED complaining of progressive R eye pain and decreased visual acuity after a wooden plank stuck him in the face at work about 2 hours prior. He denies other injuries, denies LOC, denies…
34 year old male with PMHx quadriplegia 2/2 GSW 8 years prior, with elective tracheostomy after his early disease course was complicated by frequent intubations for sepsis, presents to ED from NH with fever x1 day. On arrival, pt is febrile…
Endocarditis Pearls H&P – Flu like symptoms + murmur – Janeway lesions – painless, red macule/patch, palms/soles, culture bacteria from the lesion, embolic manifestation of endocarditis – Osler nodes- pai…
