You get a patient in triage with an anterior shoulder dislocation that happened 10 minutes prior to arrival. It’s happened to him multiple times on the same shoulder and all he did to dislocate it was to push up from a chair. You real…
We’ve all experienced it. There’s an intubated patient who is stable, saturating >98% on pulse ox, and then all of a sudden you hear the monitor start alarming and the SpO2 is plummeting. Lets assume that all other vitals are…
You get a EKG that’s a sinus rhythm but it has widened QRS waves. You remember learning about bundle branch blocks at some point back in medical school but thought it was confusing and never bothered to learn the difference. Here…
Metformin has been known to be associated with increased incidence of lactic acidosis. Metformin is renally excreted. Increased Metformin concentration leads to increased risk of lactic acidosis. IV contrast causes nephropathy leading to in…
How do you know if your patient’s port-a-cath can withstand power injection of CT contrast? All patients should carry a card that identifies the type of port-a-cath they have. However, many patients have lost/forg…
76 y M p/w chest pain after using cocaine. EKG is below. What medications should be avoided in this patient? This EKG demonstrates sinus bradycardia with ST elevation in leads II, III, aVf, v3, v4, v5 and v6, suggesting inferior wall MI. In…
10 y F p/w right neck pain starting last night, she has decreased ROM with her head tilted to the left. This child has atlanto-axial subluxation, sometimes called Grisel syndrome. The key to identifying this condition and differentiating it…
18y M no PMH p/w 2 days of gradually worsening intermittent abdominal pain and distension. Supine abdominal film of cecal volvulus demonstrating classic “coffee bean” shape and evidence of obstruction with distended proximal bow…
Ketofol, Propofol, or Ketamine + Propofol? In a recent study published in Annuals of Emergency Medicine, Ketofol (1:1) vs. Propofol alone were studied for ED procedural sedation and analgesia. The two agents were compared for adverse respir…
In ED, we often encounter patients with known HIV infection but unknown CD4 count. Any quick way to estimate the CD4 count so we can use it to guide treatment? Thanks to Dr. Jacob Isserman, who recommended a retrospective cohort study publ…
24 year-old male, presented with multiple painful genital ulcers. Herpes or chanchroid? This is a question that came up during our most recent Core Didactics. Take a look at the pictures. Which one is which? Herpes – caused by Herpes Sim…
A 60 yo F with sudden onset loss of vision in right eye, painless. Proceeded by a few episodes of amaurosis fugax. Physical exam: pupils appear normal on initial inspection, however afferent pupil defect noted. Fundoscopic exam: cherry red…
55 Chinese woman, no PMH, no meds. P/w epigastric discomfort x 2 weeks, not responding to Pepcid Maalox. Presented to Elmhurst ED for worsening epigastric discomfort and generalized weakness. No fever/chill. + Mild dry cough. No chest p…
Which of the following deficits below the level of injury is consistent with anterior cord syndrome? Loss of total sensation and motor function Bladder and bowel incontinence and loss of motor function Loss of motor function only Loss of vi…
Retrobulbar hemorrhage can result in what devastating condition? Corneal abrasion Hypopyon Central retinal artery occlusion (CRAO) Hyphema Corneal ulcer Answer: Central retinal artery occlusion (CRAO) Retrobul…
