What do you think?
Diagnostic abdominal paracenteses are frequently performed in the ED for patients with known liver disease. What complications can occur? What if the INR is elevated, as in many patients with liver disease?
You are taking a water break during your resus shift when you hear “clinical upgrade, acute zone 1”. You rush back to see a 60-year-old patient holding a bucket of bright red blood and you find out that he has an extensive PMH including Hep…
Your patient is 54 years old, otherwise healthy, and presents with symptoms of achalasia. He has a follow a up appointment with a gastroenterologist in one week but is having severe pain and regurgitation with meals and is not able to move…
@JoePinero Quick Case: 17 mo M child presenting with painless bright red rectal bleeding x 1 day. Benign physical exam. Afebrile, with stable vitals and normal labs. Dx: Meckels Diverticulum T99 scan for diagnosis (Sensitivity 85-97%, Speci…
@JoePinero – Cannabinoid hyperemesis syndrome (CHS) is a rare diagnosis to make but can save a lot of time and frustration if you can make it. It is typically seen in young males who are frequent users of marijuana, presenting with se…
@JoePinero GI bleeds have been a subject of significant research over the past decade. Let’s review the Rockall risk stratification tool. RISK STRATISFICATION TOOL ROCKALL SCORE: Score > 3 = good prognosis (rebleed < 11%, mortal…
Case: You are working in the resus room, when a 65yoM h/o CAD, severe aortic stenosis, dilated cardiomyopathy (EF 15%), presents short of breath in extremis. VS: 75/60, HR 119 RR 24, T98.0, Sp02 94% on NRB He has rales to the apices of the…
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…
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…
4 teasers for the 4th of July weekend. 1. What is this and why is it dangerous? 2. Patient had a DVT + PE, then got an IVC filter, then had another PE. How? 3. Fun Sporcle quiz – 3 letter body parts, 2 min 4. Higher level Sporcle quiz…
1. A 14 month old child is brought into the ED for fevers, vomiting, diarrhea x 4 days. Stools are watery and nonbloody. The infant appears nontoxic and well hydrated. The patient attends day care. What is the most likely diagnosis? a) Camp…
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…
70 yo F presents with RUQ pain, fever, and AMS. What is the diagnosis?
An 11 day old infant presents to the ED with persistent emesis after every feed, along with progressive yellowing of skin since birth and a 30% weight loss since birth. Physical exam reveals normal vital signs and a jaundiced, slightly leth…
