Daily Em Pearl, 4/21/12

An elderly man presents to the ED after falling down a flight of stairs at home. He has mild but worsening dementia and his wife called EMS when he couldn’t stand up from the fall. Your patient still does his own ADLs but is progressively forgetting things, like where he put his keys and toRead more

Daily Em Pearl, 4/20/12

A young woman precipitously delivers a 34wk gestation neonate in your ED. The mother is physically doing well and you turn your attention to the neonate, whose HR is 105 but falling. You prepare for a possible neonatal intubation and alert the NICU. Peds is on the way and you begin your resuscitation of theRead more

Ponte Vedra Ultrasound Course 2012

We are pleased to present our annual critical care ultrasound pre-conference course at the Clinical Decision Making in Emergency Medicine symposium in Ponte Vedra, Florida on Wednesday, June 20. Each year this intensive, hands on course features ultrasound faculty from across the country working in small groups with live models and plenty of hands-on scanningRead more

Daily Em Pearl, 4/19/12

A 6yoM is brought by his guardian for intermittent crying, c/o abd pain for the past two days; he has vomited 4times over the past 2days. He has had no fever and has never had anything like this before.  At home his urine has been dark, and this morning, possibly bloody. He has no medicalRead more

Daily Em Pearl, 4/18/12

Early in the morning, a young man p/w R-great toe pain after having his foot stepped on while dancing last night (a few hours ago). On exam, you appreciate full ROM and strength but your patient is pretty uncomfortable. He took paracetamol and ibuprofen at home with minimal relief. There are no signs of infectionRead more


Emergency physician, intensivist, and Mount Sinai Emergency Ultrasound Fellowship graduate Dr. Robert Arntfield is making news at his new home, London Health Sciences Center (LHSC) in Ontario, Canada. Dr. Arntfield and his department have set up a hardware and software infrastructure for bedside ultrasound which allows for electronic data storage and retrieval, robust QA, teachingRead more

Daily Em Pearl, 4/17/12

Today’s pearl is courtesy of the AM report. When evaluating the lethargic pediatric patient there’s lots to consider. Here’s a mnemonic, that if you can remember it (write it down) could be elucidating.   Carbon monoxide poisoning Overdose Metabolic derangement/disorder Abuse/alcohol/asphyxia Trauma Organic acidosis (that’s metabolic d/o again) Seizure/shock Encephalopathy Psychiatric disturbance Acidosis/alkalosis Tumor Insulin/intussusception EndocrineRead more

Daily Em Pearl 4/16/12

A 55yoM is BIBEMS after an MVC c/o RLE pain w/obvious deformity at the thigh. Distally he is NVI but is in excruciating pain. The portable plain film shows a mid shaft fracture. You order dilaudid but he’s still really uncomfortable. How can you help him?  Read more

Daily Em Pearl 4/15/12

A pleasant 64yoM w/NIDDM and afib (on coumadin) p/w an abscess to R-medial thigh. He is afeb but there is some surrounding erythema at the abscess site. You perform a thorough incision and drainage and instruct him to return in 2days for wound check; he is discharged with bactrim DS 2tabs BID for 10days. HeRead more

daily EM pearl, 4/14/12

A young woman is BIBEMS to your trauma bay. She has been assaulted, has multiple signs of trauma with a GCS of 6 and saliva is noted to be pooling in her mouth and onto the bed. After a swift and successful intubation you further assess the patient. Her right eye is proptotic and sheRead more