Daily EM Pearl 3/30

A 50yoM with h/o MI >5 years ago presents with a heart rate of 150, only complaining of palpitations, and otherwise normal vital signs. States he was told he had some type of arrhythmia in the past with similar symptoms, and was given a medication that quickly resolved the symptoms. The ECG is shown below.Read more

AIUM 2012 Preconference

This year AIUM is hosting its annual conference at the JW Marriott Desert Ridge Resort and Spa in Phoenix, AZ. The first offering by the Emergency and Critical Care Community of Practice was a great success. The conference proper hasn’t even started yet and the sessions have already started off with a bang. Moderator BretRead more

Ultrasound in Hypotension

Many of our lectures reference the same pantheon of literature on ultrasound in the acutely hypotensive patient. For ease of reference here they are, with appropriate links to the original publications: UHP protocol Rose JS et al,  Am J Emerg Med 2001 (PMID: 11447518) Trinity Protocol Bahner D,  JDMS 2002 RCT of ultrasound in hypotensionRead more

Daily EM Pearl 3/29

Today’s pearl was inspired by Vincent Roddy A 38-year-old man presents to the emergency department 6 weeks after Roux-en-Y gastric bypass with recurrent abdominal pain, nausea, and bilious vomiting. He has had 3 total episodes during the past month, with each episode being more severe than the last. He describes the pain as a crampy, periumbilical pain relievedRead more

Daily EM Pearl 3/28

 A 30yoM presents with a GCS of 7 after a trauma to the head, shallow respirations, saturating 100% RA, otherwise normal vitals. You decide that the patient needs to be intubated and begin preparing your equipment. You place the patient on high flow nasal cannula. Your attending asks that you hold your standard bag valve maskRead more

Daily EM Pearl 3/27

A 6 day old baby presents pale and lethargic. HR 200, BP undetectable, O2 saturation 90%, RR: 40, finger stick 20. You give dextrose but symptoms do not improve. You suspect congenital heart disease and confirm this with a hyperoxia test. You then administer an intervention but the baby subsequently becomes apneic. The patient isRead more

Daily EM Pearl 3/26

A 66yoM with advanced CHF s/p LVAD, who was in his usual state of health, presents because he felt his AICD fire multiple times. In the ED, his rhythm shows ventricular tachycardia. A pulse, blood pressure or oxygen saturation cannot be obtained but the patient appears well, is mentating well, and has no complaints. WhatRead more

Daily EM Pearl 3/23

A 60yoM with h/o hypertension presents with palpitations x 24 hours. He has never had this before. In the ED, he has normal vital signs but his rhythm shows atrial fibrillation. You do blood tests including a ddimer, BMP, troponin, and a chest xray, all of which are normal. You are well read on theRead more

Daily EM Pearl 3/22

In light of the ultrasound conference that very few of us could attend: A dialysis patient presents with mild hypotension and respiratory distress. Bedside ultrasound was done with the parasternal long view shown below. You are unable to acquire any other good views because you are not good at ultrasound. Which of the following isRead more

Daily EM Pearl 3/21

A 30yoM stabbed in the left 4th IC space suddenly arrests as he rolls into the trauma bay. You perform a left sided thoracotomy, open the pericardium, to find a laceration to the left ventricle which you put your index finger over, successfully stopping the bleeding. However the heart appears to beating irregularly and youRead more