Case: You are working in the resus room, when a 65yoM h/o CAD, severe aortic stenosis, dilated cardiomyopathy (EF 15%), presents short of breath in extremis. VS: 75/60, HR 119 RR 24, T98.0, Sp02 94% on NRB He has rales to the apices of the lungs bilaterally. Loud systolic murmur radiating to his carotids. He […]
Patients with lower quadrant pain should typically have gonadal examinations. There are relative exceptions–such as virginal women without history of pelvic examinations or IBD patients with symptoms very typical of previous IBD flairs–but gonadal examinations should still be considered in these patients. Ideally, these examinations should take place before CT imaging. Patients with previous […]
A 28 yoM comes in with hand pain after falling on an outstretched hand. His xray is as follows. What is the diagnosis?
CASE: 40yoM no PMHX with a swollen, painful right hip joint. Worsening x5 days. No history of prior episodes, no other joints involved, no fever, no trauma, no GU symptoms, no rash, no vision changes, no IVDU. On exam, pt is afebrile, nontoxic appearing. The hip is warm. You are able to range his hip, […]
26 yoF 36 weeks by dates presents to the ED in labor, and has a precipitous birth in the resus area. The infant is covered with a greenish liquid the consistency of split-pea soup. How do you address this?
Tip of the hat to Dr. Blaivas who forwarded the link to this free OB GYN ultrasound ebook. The book is a PDF download. Â The authors also maintain a fairly extensive YouTube Channel that is worth a look. Phil
CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopathic simply by having ESRD? If so, should we address it with any particular medication?
55 yoF h/o HTN presents BIBEMS with acute onset decreased level of consciousness, onset 3 hours prior to arrival. BP 220/140 HR 50 T 98.0 RR 10 SPO2 92%. Pt is obtunded, no localizing neuro findings. Pt intubated for airway protection. CT shows 30ml intracerebral hemorrhage. What are your management goals for blood pressure?
In the ED we often provide first line care for patients as the result of traumatic events. Beyond attending to clinically apparent injuries, pain, and distress, we would be in a position to apply prophylactic treatment to attempt to prevent PTSD, a debilitating sequela of trauma, if such treatment were to exist and founded in […]
A 75M presents with several days of cough, fever, and progressive lethargy. CXR demonstrates RLL pneumonia. BP 70/50. HR 130. Lactate 5. T38.0 2L bolus NS given. Antibiotics started. Bedside sono shows noncollapsing IVC, hyperdynamic LV. Recheck BP 72/50. Lactate 5.0 DX: Septic shock. Plan: Central line, start a pressor, then intubate. Question: What pressor […]
