Myasthenic Crisis

Posted on by Sarah Ring Gibbs

Myasthenia Gravis: Disease Overview Who: Bimodal distribution. Ages 20-40 (female predominance) and 50-70 (male predominance). Increased risk of onset in postpartum period; juvenile and congenital forms possible What: At the NMJ, Ach receptors are blocked by antibodies = decreased muscular contraction. Associated with fluctuating weakness. Home Treatments: Pyridostigmine (AchE inhibitor); +/- glucocorticoids, azathioprine, mycophenolate (immunosuppression) […]

Let’s Talk About Bicarb

Posted on by Fred Milgrim

If you’re like me, when you treat hyperkalemia, you make things easy on yourself and open up that HyperK orderset, or think about the mnemonic C BIG K DROP (Calcium, beta-agonist/bicarb, insulin, glucose, Kayexalate (Lokelma actually), Diuretics, ROP (“renal unit for dialysis of patient”). Then you move on with your life, recheck the BMP and […]

Burn Management

Posted on by Benjamin Hong

Trauma Survey: Burns are trauma, treat these pts as such. Don’t let yourself get distracted by the obvious superficial injuries/wounds and be sure to go down your algorithm so you don’t miss anything. PRIMARY: Airway: Look for signs of active or potential airway compromise/inhalation injury (e.g. soot, edema, or burns on the face, in oropharynx/nares, stridor, AMS). […]

Dripping in that Sedation

Posted on by Benjamin Hong

Today’s pearl: SEDATION DRIPS Titrating the sedation regimen on the sickest of patients can be one of the most challenging parts of the MICU. Anecdotally, many COVID+ vented patients in particular need at least 2, sometimes 3 different meds running at high doses to keep them comfortable, a phenomenon that also seems to have been noted in […]

Calcium Channel Overdose

Posted on by Fred Milgrim

For those who could not make it to VMR, we went over a truly sick calcium channel blocker overdose case. If not, here’s a quick rundown, and a link to the slides.   Briefly, the case was a 17-year-old female who reportedly overdosed on 60 mg of amlodipine (poor collateral, could have been more than that). […]

“Doc, I’m Blind!”
Posted on by Benjamin Hong

Super cool case, admittedly, maybe not a super high yield diagnosis BUT, I hope we can all agree, still very dope. Case: CC: 46yo M p/w worsening b/l vision over 1mo, now blind.  Vitals: WNL PMHx: L eye global rupture ~6mos ago 2/2 nail penetration requiring repair Pertinent HPI: First noticed previously injured L eye VA worsening, then good R […]

MRI Basics
Posted on by Ben Hong

As the stellar EM provider that you are, you’ve probably gotten pretty great at independently reading CTs, XRs, and even formal ultrasounds at this point. But what about the mysterious MRI? You know your consults need them, the radiologist will eventually read them, but it’s something that we don’t do ourselves quite often enough, usually […]

A can’t miss head CT finding
Posted on by Fred Milgrim

For today’s TR pearl, I’d like to take you back to January 2020, when covid was just a foreign virus and I was a fresh-faced intern, shadowing one of our recent grads, Dr. Sengupta in the cardiac room, along with Dr. Meyers. EMS called in a prenotification for a 63-year-old who was found by her family that […]

To send home or not – AC in nephrotic syndrome
Posted on by Dan McConnell

This deep dive came from a question posed during a morning report by Jackson. Jackson presented the case of a patient presenting with a swollen penis at MSBI, found to have low albumin and diagnosed with nephrotic syndrome. These patients are somewhat uncommon but come with interesting pathophysiology. The reason they present with edema and […]

Blood on the Dance Floor
Posted on by Abia Abia

We’ve all seen that movie where some old person coughs into a handkerchief and as the camera slowly pans away, there’s some blood stain. You know that guy isn’t making it to the end of the movie… Today, let’s talk about a less commonly featured troupe: Massive Hemoptysis Massive Hemoptysis is defined as hemoptysis > 1000ml […]

What with all these eyes?
Posted on by Dan McConnell

As it may become very apparent, I take a lot of photos of interesting eye pathology. So what do you think is going on here? What if I told you that this had been going on for the past few days and they had been using steroid drops in the eye? No prior surgeries in this eye.  […]

Protect Your Neck…I Mean Esophagus
Posted on by Abia Abia

2 weeks ago, I had a patient presenting with an upper GI bleed. Despite aggressive treatment, the patient was still hypotensive and actively bleeding. Unfortunately, the GI fellow was on home call and further than expected from the hospital, but after telling him, “I’m placing a Blakemore,” he hurried in. That was a lie, I didn’t […]

Visual Diagnosis
Posted on by Dan McConnell

What do you think is going on here? So if you were the resident who signed up for this patient what would you do? As may be obvious, this is herpes zoster ophthalmicus, which is a reactivation of the VZV in cranial nerve V ophthalmic division. It’s a can’t miss visual diagnosis. Patients most at […]

GI Decontamination
Posted on by Jason Huo

Case: 37-year-old M presenting with obtundation and possible seizure-like activity after a large overdose of sustained-release bupropion (Wellbutrin XL), gabapentin, and other unknown medications. Given the severity of this patient’s overdose, he was intubated for airway protection and for further GI decontamination, including gastric lavage, activated charcoal, and whole bowel irrigation. Overview Given that GI […]