Nailbed Lacs

A young man comes into your ED after slamming his right middle finger in the door. You see a large gash over the nail, and your hand specialist is not available to take care of the injury. What do you do? picture is from lacerationrepair.comRead more

My Face is Swollen!

A 15yo girl comes into your ED complaining of unilateral facial swelling that started this morning as a little bit of swelling under her R ear, and 8 hours later, is now her entire R cheek. No fevers/chills. ROS otherwise negative. VS normal. Exam with induration to the R cheek, non tender, no overlying erythema.Read more

Pediatric Fever & Rash

A 3yo M no sig PMH, IUTD, comes into your ED with complaint of 3 days of fevers, diffuse rash worst on the R hip, mild limp, N/V, no urine output today, and lethargy. On exam, found to be febrile to 40.1, tachy to 197, BP 90s/50s, sat 96%. Irritable but awake. HENT with bilateralRead more

Talking About Goals of Care

Highlights from a rundown on end of life discussions in the ED taken from a lecture by Ashley Shreves: “…not all dying pt should have CPR. Some evaluation should be made before proceeding. The cardiac arrest should be sudden and unexpected, the patient should not be in the terminal stages of a malignant or otherRead more

Tall R in V1 Differential?

My CCU attending asked me to, if nothing else, remember 3 causes of a tall R wave in V1. In my diligence I have indeed remembered nothing else. What’s in your differential?  Read more

Woke Up with Weak Legs

30 y.o. M PMHx hyperthyrodism, who presents c/o b/l leg weakness since this AM. Pt states he awoke with the symptoms and was unable to stand. Feels that his weakness is located in his thighs. Had similar episode 4 days ago, went to OSH and symptoms had resolved. Denies numbness, other neuro complaints, changes inRead more