55 F W/ Headache, Aphasia and Low-grade Fever

Post by @FTeranmd 55 yo F with PMHx of asthma who presented to the ED complaining of headache, low grade fever and word-finding difficulty. On further interrogation, patient endorsed having eaten Brie cheese recently. Her medications included albuterol and inhaled fluticasone. In the ED patient was uncomfortable-appearing, with VS: T 101, HR 105, BP 130/70, […]

What Do You Mean You Don’t Have Your Icd Card?!

Post by @FTeranmd Image from Jacob et al. Heart Rhythm. 2011 Jun;8(6):915-22 We’ve all had a patient who shows up at the ED with a pacemaker or implantable cardioverter-defibrillator (ICD) that may be malfunctioning.  The patient didn’t bring the manufacturer ID card and isn’t sure about the make or model. So there you are, looking […]

Approach to the Bleeding Tracheostomy in the Ed

Post by @FTeranmd   Clinical scenario: 72 yo F with history of lung carcinoma with permanent trachestomy placed four  months prior presentation, brought by EMS with profuse, active bleeding from the stoma site. Patient is ventilator dependent and is being assisted with BVM at arrival. Per nursing home staff bleeding was noted an hour prior presentation […]

Intermittent Visual Symptoms

57 yo M with PMHx of uncontrolled DM and HTN who presents with 3 weeks of intermittent  visual problems. Patient reports he sees flashes on both left sides of visual fields in both eyes. He is also unable to process 3D spacing and has trouble walking and reading due to vision problems. Episodes of symptoms […]

Sepsis and Ppm Failure

85 yo M with PMHx of CHF, paroxysmal atrial fibrillation and dual chamber PPM placed for sick sinus syndrome, who presents with lightheadedness, confusion and progressive lethargy x 1 day. At arrival to the ED patient hypotensive 70/30, bradycardic 46 x min, febrile 102 F. EKG is obtained         Initial labs are […]

Twisted Ankle

A 32 yo M presents with ankle pain and swelling after forcefully externally rotating it while playing soccer. He is unable to ambulate.  Ankle x ray is shown below. What other joint should you image?

Pearls for Meningitis

1. In a patient with suspected meningitis, should you give dexamethasone? 2. In the same patient, how much time do you have after giving empiric antibiotics to perform your LP?

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