What Do You Mean You Don’t Have Your Icd Card?!

Post by @FTeranmd Image from Jacob et al. Heart Rhythm. 2011 Jun;8(6):915-22 We’ve all had a patient who shows up at the ED with a pacemaker or implantable cardioverter-defibrillator (ICD) that may be malfunctioning.  The patient didn’t bring the manufacturer ID card and isn’t sure about the make or model. So there you are, lookingRead more

Approach to the Bleeding Tracheostomy in the Ed

Post by @FTeranmd   Clinical scenario: 72 yo F with history of lung carcinoma with permanent trachestomy placed four  months prior presentation, brought by EMS with profuse, active bleeding from the stoma site. Patient is ventilator dependent and is being assisted with BVM at arrival. Per nursing home staff bleeding was noted an hour prior presentationRead more

Intermittent Visual Symptoms

57 yo M with PMHx of uncontrolled DM and HTN who presents with 3 weeks of intermittent  visual problems. Patient reports he sees flashes on both left sides of visual fields in both eyes. He is also unable to process 3D spacing and has trouble walking and reading due to vision problems. Episodes of symptomsRead more

Sepsis and Ppm Failure

85 yo M with PMHx of CHF, paroxysmal atrial fibrillation and dual chamber PPM placed for sick sinus syndrome, who presents with lightheadedness, confusion and progressive lethargy x 1 day. At arrival to the ED patient hypotensive 70/30, bradycardic 46 x min, febrile 102 F. EKG is obtained         Initial labs areRead more

Twisted Ankle

A 32 yo M presents with ankle pain and swelling after forcefully externally rotating it while playing soccer. He is unable to ambulate.  Ankle x ray is shown below. What other joint should you image?Read more

Pediatric Hypoglycemia

A 3 year old M presents to the ED with lethargy.  Fingerstick is 38. How do you give this kid sugar??Read more

Wernicke’s Encephalopathy

Classically presents with which triad of clinical features?Read more


What lead level in blood requires chelation therapy?Read more

WCUME 2014

The Third Annual World Congress on Ultrasound in Medical Education was hosted at the Oregon Health and Science University in Portland. Co-sponsored by SUSME and WINFOCUS, the conference highlights research and innovation in ultrasound for education. Over 500 students, residents, and educators from all specialties around the world were in attendance. Bret Nelson presented researchRead more

Pearls for Meningitis

1. In a patient with suspected meningitis, should you give dexamethasone? 2. In the same patient, how much time do you have after giving empiric antibiotics to perform your LP?Read more