Scuba Do

A 33 yo  man presents to the ED with multiple complaints 2 hours after completing a scuba dive.  Which of the following symptoms indicates a need for recompression therapy? Decreased hearing Ear pain Epistaxis Knee pain Petechial rash

My Aicd Won’t Stop Firing!

65 yo M PMH of HTN, CAD, CHF (EF <30%), AICD wheeled into the cardiac room saying that he is getting shocked every 30 seconds. Vitals: T 36 HR 45 BP 205/100 RR 30 O2 sat 100% RA. Pt is placed on a monitor, EKG done which shows atrial fib…

Can’t Put My Finger on It

A 29 year old male resident presents to the local emergency department directly from the residency ski trip.  He was cruising down the slopes at  high speed, hit a hidden patch of ice and fell onto his right hand, hyperextending his thumb….

Face off

A 29 y/o M presents to your ED after a head-on MVC at moderate speed.  The patient was driving an older automobile without airbags, and smashed his face hard against the steering wheel.  He has significant facial ecchymoses and swelling, an…

Ouch, My Back

34 yo M BIBA s/p fall from 3 stories, suicidal attempt. Pt is AO3, CTA b/l, pelvis stable, able to lift all extremities off stretcher, sensation and peripheral pulses intact. Pt has right lateral heel/ankle deformity. +step off L1-L2 area,…

Urinary Tract Infection & Pregnancy

An 8 month pregnant female arrives to the ED complaining about dysuria. She is nontoxic appearing, afebrile. Exam significant for +suprapubic tenderness, -CVA tenderness. UA +leuks, +nitrates. 1) What antibiotic regimen should she be starte…

More Than Just Teenage Angst

An 18 year old female presents to the ED with vague symptoms of lower back pain. She exhibited inappropriate and erratic behavior that seemed more than just teenage angst. The patient was thin in NAD and had a grossly normal musculoskeletal…

Cqr Qtip

QTip: Patients with new neurologic deficits that present outside the reperfusion window or with unknown duration of symptoms may have a time-sensitive dangerous condition other than acute ischemic stroke (e.g. intracranial hemorrhage) and s…


A 46 year old female with a history of rheumatoid arthritis, on daily steroids, presents complaining of abdominal pain, nausea, and vomiting x 5 days. She has been unable to tolerate PO, including her medications for the past three days. Up…

January 2014