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?

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…

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 obt…

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…

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…

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 th…

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…

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 r…

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 le…

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.

Ocean Surprise

48 y/o M presents after dredging for clams off the coast of Long Island. He reports finding a metallic object in his net, then throwing it overboard. Over the next two hours he develops the following…. What’s the diagnosis?

5 y/o F presents to the ED feeling “uneasy.” She is noted to have a pulse of 140 and BP of 180/110 and is profusely sweating. She is on imipramine for bedwetting, no other PMH. Pupils are PERRL. Exam is otherwise unremarkable. CBC, BMP, UA…

Bloated and Upset

47 y/o female PMH appendectomy presents with three days of worsening abdominal pain and constipation. Over the past day she has had persistent vomiting. She appears ill and has a diffusely tender abdomen. You quickly order labs and an obstr…

Confused and Hypertensive

52 y/o female with a PMH of HTN and HLD presents with mental status change over the past 12 hours. She is non-compliant with medications and her initial BP is 252/130. Physical exam shows pt is A&Ox1, with an otherwise normal neuro exam…

Slow and Steady….

75 y/o M with a past medical history of atrial fibrillation presents to the ED not feeling well for several days. He has some diarrhea but has continued to take his medications. He is mildly hypotensive. While IV access is established, you…

May 2015
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