You are working resus at 3 am when you hear an alarming vent. It’s the patient in room “E” who is intubated and has been admitted for 36 hours waiting for a stepdown bed. The patient is satting 99% and you are tempted to just hit the sile…
Ventilator management can be very simple or complex. As boarding continues to plague the emergency department, ventilated patients become more commonplace. The emergency physician should be well versed in ventilator settings as well as acti…
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…
This pearl is based off a question on our in-service yesterday. You are working resus and a 63 yo M presents with altered mental status. He has a LVAD. His EKG is below: Time to call the LVAD team right? Well what if you can’t reach…
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…
A 65 yo M is rushed into the resus room. He is pale and is vomiting a mixture of coffee ground emesis and bright red blood. His vitals are stable currently but he is continuing to vomit in the emergency department. This patient requires a d…
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…
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…
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…
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…
Abducens (CN VI) Nerve Palsy CN VI causes contraction of the lateral rectus muscle, allowing the eye to abduct. An abducens palsy will present with impairment of lateral gaze of the affected eye. Causes of an Abducens palsy include:…
A recent systematic review in Pediatric Emergency Care attempted to identify the most reliable clinical, biological, and radiological signs of ovarian torsion in the pediatric population. Ovarian torsion is a rare but serious cause of abdom…
An uncommon fracture can be easy to miss, and if you do not look for it, you might not see it. Scapula fractures – Typically seen in association with other injuries in setting of major trauma, but may be missed in the patient with sho…
In patients with not immediately life-threatening blunt chest wall trauma, it can be difficult to decide which patients may require hospitalization and which patients can safely return home. A systematic review assessing risk factors for mo…
