An 8 year old female is brought in by her mother after falling off her scooter one hour ago. She was not wearing a helmet, and hit her head on the ground. Patient and mother deny LOC. On exam, she is well-appearing, playing with her mother…
QTip: Some patients who are discharged with few or no diagnostics (e.g. xray) or treatments (e.g. antibiotics) feel as though their evaluation was inadequate. Taking an extra minute or two to explain why these interventions aren’t ind…
Aortic dissections are insidious killers that are often undetectable by history and physical exam alone. Obviously, providers must have a high index of suspicion for these as their presentations are highly variable. CT angiography, and less…
Thanks to Dr. Kedia for today’s daily pearl: you have a patient with suspected anticholinergic overdose and a prolonged QRS. You give bicarbonate and it normalizes. You want to give physostigmine, but don’t know the contraindica…
A young woman presents with dysfunctional uterine bleeding. Exam is unremarkable and she has no concerning medical history. She has not symptoms of anemia. She asks about medications to control the symptoms.
A 50 year old male presents with sudden onset of severe right scapular / shoulder pain of 4 days duration. He denies cervical neck pain, no history of trauma, no recent surgeries. No fever/chills and no bad habits. On exam you note full ROM…
It’s time to start studying for the in-service exam. Eponymous fractures are some of the easier points. What are the two more common eponymous fractures of the forearm and how can you remember them?
By Dr. Raashee Kedia Acute vision change A 51 year old female with a history of diabetes presented to the ED with acute onset of left eye painless blurry vision. Vitals were within normal limits. Fingerstick was 450. On exam : Visual acui…
Premature neonate resuscitation pearls courtesy of Dr. Jennifer Sanders. Neonates have a high surface area to volume ratio and thin underdeveloped skin – this results in rapid heat and fluids loss. There are many documented ways to ma…
A young emergency medicine nurse asks you to take a look at a rash she has developed over the last 2 weeks. She noted a single lesion on her back which is painless and not pruritic approximately 10 days ago (see below). She developed anoth…
A 45F with a PSH of silicone breast implants in ’99 comes in to the ED after slipping on some ice and falling onto her chest. She is concerned that an implant broke and that she’ll “get blood poisoning or cancer” if the implant isn’t…
Back to our patient from several days ago – 65M with HIV/AIDS, CD4 count 24, and prior CNS toxoplasmosis *compliant with his secondary prophylaxis treatment*, now BIBEMS for new AMS. The head CT (WITH contrast) showed no new lesions,…
Matt Bai decided to get his cat a turkey for Thanksgiving and went off to Central Park with a bow and arrows to find one. Unfortunately he just winged the biggest turkey, and it attacked and bit him. He came into the ED wondering if he sh…
A 45M with no PMH is BIBEMS for AMS. In the ED, he is obtunded with pinpoint pupils, respiratory depression, and an O2 sat of 90% on a NRB. He does not respond to sternal rub. His partner comes in and states that they were at a bar a few…
A 65M TCC resident with a PMH of HIV (CD4 count 24, VL 12K), cerebral toxoplasmosis in 2012, seizure disorder on keppra 1000mg BID, and endstage dementia was BIBEMS from TCC at noon for status epilepticus x 1.5 hours. He had not had his an…
