Clinical Scenario:  A 66-year-old male with a past medical history of traumatic brain injury and frequent urinary tract infections sent from his nursing home with hypernatremia. On a routine blood draw he was found to have hypernatremia to 160. His mental status is unchanged. How do you correct his hypernatremia? Hypernatremia is caused by ExcessiveRead more

52 in 52: Rate vs. Rhythm for A fib

Article Citation: Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, et al; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002 Dec 5;347(23):1825-33. PMID: 12466506 Resident Reviewer: Courtney Cassella What we already know about the topic There areRead more

Low Back Pain Exam

Clinical Scenario: A 28-year-old male with no significant past medical history presents with low back pain for 6 days. His pain started after playing soccer. The pain is severe, sharp, and radiates down the left leg. The pain limits his ability to walk. He has been taking ibuprofen every 6 hours without relief. Today heRead more

Imaging in Intussusception

Clinical Scenario: A 2-year-old female with no significant past medical history presents with vomiting and abdominal pain for 1 day. Among other entities in your differential diagnosis you are considering intussusception, however it is lower on your differential. How would you work-up this child?   Presenting Symptoms for Intussusception1 Sudden onset of intermittent, severe, crampy,Read more

52 in 52: Emergency Department Thoracotomy

Article Citation: Moore EE, Knudson MM, Burlew CC, Inaba K, et al; WTA Study Group. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011 Feb;70(2):334-9. PMID: 21307731 Resident Reviewer: Courtney Cassella What we already know about the topic: Resuscitative ED thoracotomy (EDT) is a resource intense procedure withRead more

Imaging in Clostridium difficile infection

Clinical Scenario: A 68-year-old man with a past medical history of diabetes mellitus, hypertension, and recent admission for pneumonia presents with fever and diarrhea for 5 days. The patient has had multiple watery stools per day. Associated symptoms include mild vague abdominal pain but no nausea or vomiting. Exam is notable for mild diffuse abdominalRead more

Good news you’re pregnant… Now what?

Clinical Scenario: A 28-year-old G0P0, last menstrual period November 2, presents with amenorrhea. Urine pregnancy test is positive. Examination is normal. Bedside ultrasound demonstrates an early intrauterine pregnancy. After being given follow-up information and return precautions she asks for advice in order to have a healthy pregnancy. What do you tell her?   Foods toRead more

52 in 52: Ottawa Subarachnoid Hemorrhage Rule

Citation Perry JJ, Stiell IG, Sivilotti ML, et al. High-risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204 Resident Reviewer Carl Mickman Why this study is important Subarachnoid hemorrhage (SAH) is one of the most dangerous diagnoses made in the emergency department, and a large amount of resourcesRead more

Coach, I Jammed My Finger, Can I Still Play?

    Jammed fingers are a very common complaint in the emergency department, and while often sent home as soon as we verify they don’t have a fracture, there is another more serious complication that needs to be on our radar. Mallet finger, or baseball finger, is often caused by a sudden force that causesRead more

Trigger Point Injections

Back pain-related complaints account for millions of visits in emergency departments every year, and all of us have had patients that despite our best efforts aren’t satisfied with their pain control. Trigger point injections of local anesthetics well as anti-inflammatory medications have been common treatments in chronic pain and headache clinics for years, and areRead more