Norepi Vs Dopamine

A 75M presents with several days of cough, fever, and progressive lethargy. CXR demonstrates RLL pneumonia. BP 70/50. HR 130. Lactate 5. T38.0 2L bolus NS given. Antibiotics started. Bedside sono shows noncollapsing IVC, hyperdynamic LV. Re…

Stable Afib in the Ed

A 55M h/o HTN presents with 5 hours of palpitations that woke him from sleep. His complaint is that the sensation of his fast beating heart is uncomfortable. There is no chest pain, no SOB. There are no other associated symptoms. Vitals: HR…

Ultrasound is Your Friend

Pt is 54 yo M with PMH of DM, HTN, Crohn Disease presents with 2 days of worsening vomiting, had diarrhea initially that has now stopped and is no longer passing gas, also reports some slight abdominal distention. Patient has had several ab…

Meningitis

Patient is 49 yo F who presents to ED with few days of fever (T max 102F), progressive headache, neck stiffness. Patient denies any travel, rashes, sick contacts. Pt complains she can’t be in a well lit room or go outside without pain…

Sbp Pearls

Pt is 58 yo M with PMH of alcoholism, HCV with liver cirrhosis (h/o variceal GI bleeds, h/o SBP, h/o hepatic encephalopathy) presents to ED with 2-3 days of altered mental status and fever, you want to rule-out Spontaneous Bacterial Periton…

Biphasic Reactions with Anaphylaxis?

“Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients wit Allergic Reactions or Anaphylaxis” Grunau BE, Li J, Yi TW, et al. Annals of Emergency Medicine 2014; 63(6): 736-744   Background: Al…

Ultrasound Signs of Appendicitis

                  Appendicitis on ultrasound – the first step is to identify the appendix by finding a blind-ending tubular structure arising from the base of the cecum. The sonographic signs of appendicitis include: dilated…

Dimer Dimes

Quantitative D-dimer is a common screening tool to rule-out pulmonary embolism in low-risk population but is there more that it can tell us?   Yes, there have been studies linking increasing d-dimers to: 1) likelihood of PE, 2) locatio…

Severe Aortic Stenosis

Thirsty (for knowledge) Thursday   Patient is 72 yo F wtih PMH of HTN, severe aortic stenosis presented to ED with dizziness and shortness of breath, progressively worse over the last 2 weeks, both symptoms worse with exertion. Patient…

Tramadol Intox

Tox Tuesday Patient is 42 yo  M with PMH of chronic back pain (follows in pain clinic), depression BIBEMS found after wife found him with an apparent overdose attempt with an empty bottle of Tramadol next to him, last seen in USOH 4 hr prio…

Ebola

Microbio Monday   CASE 42 yo F, previously healthy, presents to ED with 4-5 days of fever, chills, nonproductive cough followed by muscle aches. Symptoms are getting worse and have not responded to OTC treatments. Patient presented tod…

August 2014
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