What Lies Beneath

24 y/o male working at the local aquarium presents with right hand redness, pain, and swelling after handling an exotic fish. He is able to snap a picture of the fish before presenting to the ED. What’s your diagnosis?Read more

Its a Bleeder

A 50 y/o M with a PMH of hypertension presents to the emergency department with epistaxis. A rhino rocket is placed. You note the patient’s blood pressure to be 196/100. He is A&Ox3 and denies any other symptoms. Should you treat this patient as hypertensive emergency and lower his BP?Read more

Fool Me Once

A 2 year old male presents with his mother with after mom saw him put something metallic in his mouth. He has no past medical problems and does not appear in any distress. His lung sounds are clear bilaterally, SpO2 99% on room air. You obtain a PA and lateral radiograph. Can this child beRead more

Burning Up

62 y/o M PMH of hep C cirrhosis, HTN, and anemia presents with fever to 101.6 and diffuse abdominal pain. Your patient has jaundice and abdominal distension and tenderness with shifting fluid wave. You work him up with labs, including a tap to rule out SBP. Can you safely use tylenol to control his fever?Read more

It Burns!

You have to close a laceration in a 5 year old and you’re preparing your local anesthesia. It’s been shown that buffering lidocaine with bicarbonate decreases the acidity of the solution and improves patient comfort during infiltration, but have you considered warming it?Read more

More Power

59 y/o M presents to the cardiac room after cardiac arrest. EMS reports a downtime of 5 minutes with immediate bystander CPR. The initial rhythm was vifb that responded to two EMS shocks and CPR. The patient arrived with ROSC. Soon after the patient goes back into VF. You try everything in the books-continuous compressions,Read more

Pregnancy Pain

A 29 y/o F 20 weeks pregnant presents with fever, dysuria, and left flank pain. She has some CVA tenderness on the right. WBC is elevated to 15. UA shows both blood and leukocytes in the urine. You are concerned about pyelonephritis vs. and infected stone. What are the risks of imaging this patient?Read more

The Trouble with Wheezing

4 month-old M PMH low birth weight presents with a 3 day history cough and runny nose.  Today his mother reports a low grade fever.  His immunizations are up to date. He has no known sick contacts, but he attends day care. His respiratory rate is 39 and is coughing frequently. On lung exam heRead more

Kidney Pains

53 y/o M PMD ESRD on dialysis presents with mild chest pain, now resolved. His EKG is unremarkable and trop is mildly elevated. There are no signs of overt heart failure. You call his cardiologist who tells you he has a “chronic troponin leak.” Should you be concerned to send this patient home?Read more

Get That Line

Vascular access in ill neonates who present to the ED can be challenging. Umbilical vein catheterization can be a life-saving option. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth.Read more