New Year’s Eye-ve

A 53 year old man presents with severe sudden onset pain in his left eye associated with nausea and cloudy vision. He describes seeing halos around lights. His symptoms started when he entered a dark nightclub where he was planning to celebrate New Year’s Eve.   What would you do next? How would you treat thisRead more

Nailed It

A 79 year old female presents the day after the New York Marathon, complaining of a painful R big toe. She wore old sneakers to run the race, her 50th marathon, and feels that her toe may have rubbed up against the toe box of the shoe. How can this be managed in the ED?Read more

Getting “nerve-ous”: Treatment of Occipital Neuralgia

39 y/o M no significant past medical history presents with severe right sided occipital headache since this morning.  The pain comes and goes, lasting a few minutes each time.  He has had these headaches before, and feels that this episode is consistent with his previous ones.  He denies fevers or chills, neck stiffness, numbness, tinglingRead more

Eye Caramba!: Management of Corneal Abrasions

A 25 year old male basketball player presents with R eye pain after being elbowed in the eye one hour prior to arrival.  The eye is tearing and very painful, although his vision is preserved, and he feels that something may be stuck in the eye. Exam of the eye shows PERRL, EOMI, 20/20 visualRead more

Thumbs Up

A 25 year old rugby player presents with R thumb pain that began yesterday. She reports that she was trying to make a tackle and was stiff-armed. She fell to the ground, landing on an outstretched hand. Her pain is localized to the MCP joint, and she has some swelling and ecchymosis of the thenar eminence. She reports difficultyRead more

Hot Math

A 25 year old male was brought into the ED after his shirt caught on fire when he accidentally leaned back while sitting near a fireplace. He has partial-thickness burns on his entire back and the posterior aspect of both arms. He weighs 85 kg. What percentage of his body has been burned? How wouldRead more

Management of Priapism: It Doesn’t Have to Be That Hard

A 12 year old patient with sickle cell disease presents to the ED with painful erection x 5 hours.   Urology is paged and suggests fluids, high flow oxygen, compresses to the area and exchange transfusion. They do not wish to aspirate blood from the penis in a patient this young, as they state thatRead more

Head Injury in Hemophilia

An 8 year old female is brought in by her mother after falling off her scooter one hour ago. She was not wearing a helmet, and hit her head on the ground. Patient and mother deny LOC. On exam, she is well-appearing, playing with her mother’s cell phone. She has a mild hematoma over herRead more

Zosyn = Nosyn

A 56 y/o male with poorly controlled diabetes s/p multiple toe amputations presents with several days of fever and foot pain.  He is tachycardic and hypotensive and appears to have an infected foot ulcer. Vascular surgery is paged, and agrees come to see the patient, and in the meantime tells you to start Vancomycin andRead more

Elmhurst Cqr Qtip

QTip: Some patients who are discharged with few or no diagnostics (e.g. xray) or treatments (e.g. antibiotics) feel as though their evaluation was inadequate. Taking an extra minute or two to explain why these interventions aren’t indicated can make your patient feel much better about their visit. Satisfaction gambits include emphasizing the harms of theRead more