Fool Me Once

A 2 year old male presents with his mother with after mom saw him put something metallic in his mouth. He has no past medical problems and does not appear in any distress. His lung sounds are clear bilaterally, SpO2 99% on room air. You obtain a PA and lateral radiograph. Can this child be […]

Burning Up

62 y/o M PMH of hep C cirrhosis, HTN, and anemia presents with fever to 101.6 and diffuse abdominal pain. Your patient has jaundice and abdominal distension and tenderness with shifting fluid wave. You work him up with labs, including a tap to rule out SBP. Can you safely use tylenol to control his fever?

It Burns!

You have to close a laceration in a 5 year old and you’re preparing your local anesthesia. It’s been shown that buffering lidocaine with bicarbonate decreases the acidity of the solution and improves patient comfort during infiltration, but have you considered warming it?

More Power

59 y/o M presents to the cardiac room after cardiac arrest. EMS reports a downtime of 5 minutes with immediate bystander CPR. The initial rhythm was vifb that responded to two EMS shocks and CPR. The patient arrived with ROSC. Soon after the patient goes back into VF. You try everything in the books-continuous compressions, […]

Pregnancy Pain

A 29 y/o F 20 weeks pregnant presents with fever, dysuria, and left flank pain. She has some CVA tenderness on the right. WBC is elevated to 15. UA shows both blood and leukocytes in the urine. You are concerned about pyelonephritis vs. and infected stone. What are the risks of imaging this patient?

The Trouble with Wheezing

4 month-old M PMH low birth weight presents with a 3 day history cough and runny nose.  Today his mother reports a low grade fever.  His immunizations are up to date. He has no known sick contacts, but he attends day care. His respiratory rate is 39 and is coughing frequently. On lung exam he […]

Kidney Pains

53 y/o M PMD ESRD on dialysis presents with mild chest pain, now resolved. His EKG is unremarkable and trop is mildly elevated. There are no signs of overt heart failure. You call his cardiologist who tells you he has a “chronic troponin leak.” Should you be concerned to send this patient home?

Get That Line

Vascular access in ill neonates who present to the ED can be challenging. Umbilical vein catheterization can be a life-saving option. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth.

Ocean Surprise

48 y/o M presents after dredging for clams off the coast of Long Island. He reports finding a metallic object in his net, then throwing it overboard. Over the next two hours he develops the following…. What’s the diagnosis?

5 y/o F presents to the ED feeling “uneasy.” She is noted to have a pulse of 140 and BP of 180/110 and is profusely sweating. She is on imipramine for bedwetting, no other PMH. Pupils are PERRL. Exam is otherwise unremarkable. CBC, BMP, UA are negative. When considering a toxidrome, what is your differential?

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