45 y  male with no known medical problems presents to the emergency department complaining of tender lump to left axillary region worsening over the last 2 days.  Pt notes that over the last 3 days he had also been having subjective fevers, chills, and HA.  Pt has never had similar issues in the past.  States that […]

A 4 y female arrives to ED accompanied by mother after witnessed mechanical fall off out of stroller (approximately 3.5 feet high) with head hitting linoleum floor.  Mom states that the child cried immediately afterwards and never experienced LOC.  Denies n/v.  Now acting normally.  Physical exam is remarkable only for a small, left parietal scalp […]

As we all know, NiPPV is a well established practice and therapy of choice in patients with COPD and CHF exacerbations.  It is typically used in patients with hypercarbic respiratory failure.  But for those patients who come to the ED with pure hypoxemic respiratory failure (in say, someone with pneumonia) is there a better way to […]

31 y M presents with n/v/d and altered sensation to hands and feet several hours after going out for a seafood dinner.  Pt states that he ate red snapper at the request of a work colleague and prior to tonight was in his USOH.  Later, during the hospital stay the patient notes that the rail […]

A 64 yo male with a history of CHF and COPD arrives with a complaint of acute onset SOB since this morning.  Lung exam is notable for diffuse Rhonchi.  You believe the patient is having a CHF exacerbation, but you’re also concerned for COPD (as well as the multitude of other pathologies that can give you […]

54 y M presents to the ED with complaints of chest pain starting acutely 4 hours ago.  The EKG is as follows: What’s the diagnosis? 

21 month old male with wheezing and cough for 6 hours.  Otherwise in usual state of health prior to lunch this afternoon.  No history of reactive airway disease.     What is the diagnosis?

You are a first day intern (literally, for many of you), the cardiac room is overflowing with patients and you are asked to set up for endotracheal intubation on a patient with declining mental status.  You haven’t intubated since your anesthesia rotation and you’re worried you may experience some difficulty with the procedure.  What can […]

A 25 y F g1p0 @8wks pregnant presents to ED complaining of SOB. Clinical suspicion for PE with a positive dimer to 0.68.  Assuming lower extremity dopplers and chest x ray are unremarkable. How will you further workup this patient? CTA or V/Q Scan?