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Ketofol, Propofol, or Ketamine + Propofol? In a recent study published in Annuals of Emergency Medicine, Ketofol (1:1) vs. Propofol alone were studied for ED procedural sedation and analgesia. The two agents were compared for adverse respiratory events, induction time, and repeated dosing required to achieve sedation.  No difference was found in all categories. InRead more

In ED, we often encounter patients with known HIV infection but unknown CD4 count.  Any quick way to estimate the CD4 count so we can use it to guide treatment? Thanks to Dr. Jacob Isserman, who recommended a retrospective cohort study published in PubMed in 2011, which concluded that there is an association between ALCRead more

24 year-old male, presented with multiple painful genital ulcers.  Herpes or chanchroid?  This is a question that came up during our most recent Core Didactics. Take a look at the pictures.  Which one is which? Herpes – caused by Herpes Simplex Virus  (picture on left) Presentation: Papules and vesicles on an erythematous base, erode inRead more

A 60 yo F with sudden onset loss of vision in right eye, painless.  Proceeded by a few episodes of amaurosis fugax. Physical exam: pupils appear normal on initial inspection, however afferent pupil defect noted. Fundoscopic exam: cherry red spot, pale retina, +/-boxcar segmentation (not shown in this picture). DDx for loss/reduction of vision: Glaucoma,Read more

55 Chinese woman, no PMH, no meds.  P/w epigastric discomfort x 2 weeks, not responding to Pepcid Maalox.  Presented to Elmhurst ED for worsening epigastric discomfort and generalized weakness.  No fever/chill. + Mild dry cough.  No chest pain. + Mild SOB with exertion.  No abd pain, n/v/d/c/dysuria.  No night sweats or weight loss, denied exposure toRead more