Sepsis 2.0 vs 3.0

A 65 yo M is bibems tachycardic and hypotensive with one week of worsening cough and sob.  Large LLL infiltrate is present on XRay.  You begin treating your patient for severe sepsis and begin to wonder what has been happening in the world…

Unstable Cervical Fractures

Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.   Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures   Jefferson Fracture A burst fracture of the…


This pearl was created in light of our impending in-service exam this Wednesday.  Hopefully reading this will give you at least 1 point on the exam. A 19 yo F ingested 150 pills of Tylenol four hours ago and is presenting now because she do…

Arntfield on TEE

We miss having Rob in NYC, but he has certainly hasn’t been slacking off in the depths of Ontarian Polar Vortices.  Here’s the latest from London on Arntfield’s ED TEE protocol.


You are working resus at 2 am when EMS rolls in with a 60 year old patient with fever and cough, hypotensive to 83/40 with a HR of 142. This septic patient needs emergent fluid resuscitation. You notice the RN about to place a peripheral IV…

Not quite a STEMI

ST elevation gets all the attention when discussing EKGs. We have special STEMI and C-port alerts making it particularly sexy. Everyone knows to look for STEMI and how to manage it (aspirin, +/- Plavix load and straight to cath lab). Howeve…

LLQ abdominal pain

A 43 yo M presents with LLQ abd pain, non-bloody diarrhea and subjective fever for 1 d. His vitals are normal, has a WBC of 14 but otherwise normal labs.  He is given IV analgesia and clinically has improved, tolerating PO.  CT abdomen and…

HIV-Related Heart Disease

CAD and ACS: Both HIV and anti-retroviral medications increase patients’ risk of cardiovascular disease HIV-infected patients tend to have a first episode of ACS at age 48 yrs, 10 years earlier than HIV negative patients Reasons for i…

February 2016