Resus SinaiEM Blog – Page 61

Stable Afib in the Ed

Posted on August 27, 2014 by sinaiem

A 55M h/o HTN presents with 5 hours of palpitations that woke him from sleep. His complaint is that the sensation of his fast beating heart is uncomfortable. There is no chest pain, no SOB. There are no other associated symptoms. Vitals: HR 145 BP 120/65 RR 12 T98.0 98% Patient is well appearing, exam […]

Ultrasound is Your Friend

Posted on August 22, 2014 by sinaiem

Pt is 54 yo M with PMH of DM, HTN, Crohn Disease presents with 2 days of worsening vomiting, had diarrhea initially that has now stopped and is no longer passing gas, also reports some slight abdominal distention. Patient has had several abdominal surgeries in the past, denies any fevers, any blood in the vomit […]

Meningitis

Posted on August 21, 2014 by sinaiem

Patient is 49 yo F who presents to ED with few days of fever (T max 102F), progressive headache, neck stiffness. Patient denies any travel, rashes, sick contacts. Pt complains she can’t be in a well lit room or go outside without pain. You have a high suspicion for meningitis and so perform an LP. […]

Sbp Pearls

Posted on August 15, 2014 by sinaiem

Pt is 58 yo M with PMH of alcoholism, HCV with liver cirrhosis (h/o variceal GI bleeds, h/o SBP, h/o hepatic encephalopathy) presents to ED with 2-3 days of altered mental status and fever, you want to rule-out Spontaneous Bacterial Peritonitis and you send your newly minted intern over to get set up for a […]

Biphasic Reactions with Anaphylaxis?

Posted on August 14, 2014 by sinaiem

“Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients wit Allergic Reactions or Anaphylaxis” Grunau BE, Li J, Yi TW, et al. Annals of Emergency Medicine 2014; 63(6): 736-744 Background: Allergic or anaphylactic reactions are fairly common presentations to the ED. After initial treatment and clinical improvement, a proportion of patients may develop a […]

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Ultrasound Signs of Appendicitis

Posted on August 12, 2014 by sinaiem

Appendicitis on ultrasound – the first step is to identify the appendix by finding a blind-ending tubular structure arising from the base of the cecum. The sonographic signs of appendicitis include: dilated appendix > 6mm outer diameter (left image) noncompressible distinct appendiceal wall layers due to edema (left image) target appearance […]

Dimer Dimes

Posted on August 8, 2014 by sinaiem

Quantitative D-dimer is a common screening tool to rule-out pulmonary embolism in low-risk population but is there more that it can tell us? Yes, there have been studies linking increasing d-dimers to: 1) likelihood of PE, 2) location of PE, and 3) clot burden. 1. The level of d-dimer has been shown that with […]

Severe Aortic Stenosis

Posted on August 8, 2014 by sinaiem

Thirsty (for knowledge) Thursday Patient is 72 yo F wtih PMH of HTN, severe aortic stenosis presented to ED with dizziness and shortness of breath, progressively worse over the last 2 weeks, both symptoms worse with exertion. Patient progressively becomes hypotension to 70’s/40’s but still responsive, you strongly suspect this is secondary to the […]

Tramadol Intox

Posted on August 5, 2014 by sinaiem

Tox Tuesday Patient is 42 yo M with PMH of chronic back pain (follows in pain clinic), depression BIBEMS found after wife found him with an apparent overdose attempt with an empty bottle of Tramadol next to him, last seen in USOH 4 hr prior. When EMS arrived on scene, noted some seizure-like activity lasting […]

Ebola

Posted on August 5, 2014 by sinaiem

Microbio Monday CASE 42 yo F, previously healthy, presents to ED with 4-5 days of fever, chills, nonproductive cough followed by muscle aches. Symptoms are getting worse and have not responded to OTC treatments. Patient presented today after noticing bleeding from the gums that have not stopped after brushing her teeth this morning, also […]

Flexor Tenosynovitis

Posted on July 31, 2014 by sinaiem

Tenosynovitis = inflammation of a tendon and its sheath. Most acute cases of flexor tenosynovitis (FT) are infectious but may also be secondary to inflammation from noninfectious cause (e.g. diabetes, overuse, arthritis) Infectious tenosynovitis May be result of trauma with direct inoculation (eg, laceration, puncture or bite), contiguous spread from infected adjacent soft tissues, or […]

Tick-borne Illness – Not All Lyme

Posted on July 29, 2014 by sinaiem

27M h/o sickle cell anemia presents with high fevers, sweats, HA, muscle aches, N/V. Recent camping trip in New England. Blood smear shows the following: Diagnosis? What complications would you worry about?

The Normotensive Pulmonary Embolism Patient

Posted on July 21, 2014 by nupur

Early death (within 7-30 days) in PE patients is concerning. It is relatively easy to identify high-risk PE patients, defined by abnormal vitals SBP < 90 or drop in SBP by 40 for at least 5 min. Normotensive patients with poor prognostic indicators include (statistically significant odds ratios): – SBP between 90-100 (OR 2.45) – […]

Young Female with Hemoptysis

Posted on July 14, 2014 by nupur

A 24 year old female from Europe presents with progressive shortness of breath and hemoptysis. O2 sat is 94%. CXR is clear. PSH includes silicone implants in gluteal area. Meds include OCPs. Travel from Eastern Europe 2 months ago. D-dimer is negative. CTA is negative for embolus. What is the diagnosis?

A Pediatric Pearl

Posted on July 11, 2014 by nupur

This week, PECARN published a study that determined that isolated loss of consciousness (LOC) is not a strong enough predictive factor for a clinically significant traumatic brain injury, which they define as requiring intubation, extended inpatient observation, and/or neurosurgical intervention (rate of 0.5% (95% CI, 0.2-0.8; 13 of 2780). The rate is slightly higher for […]