EMS calls in to the department and states they are en-route w/ an ETA of 5 minutes w/ an 8 yo M w/ no known PMHx in severe distress, no further history provided. 3 minutes later an 8 yo M is wheeled into the department by EMS, the child is obtunded, diaphoretic, and has bluish […]

23 yo M w/ no known PMHx presents to the ED BIBEMS for AMS.  Patient is awake but appears slightly confused, he is salivating and spitting in the ED but able to protect his airway and his vitals are stable, he has no signs of trauma, no abnormal odors.  He refuses to provide any history. […]

Elderly female w/ PMHx of TIA, DM, and remote breast Cancer history reportedly in remission presented to the ED w/ c/o R-sided neck pain radiating to her R trapezius for 2 days.  No fevers or chills, no Hx of trauma or falls, no vision changes, vague reporting of onset characteristic but could not recall exact […]

  For Patients in Cardiac Arrest use LMA until there is ROSC and situation under control   Induction Agents Etomidate: 0.3mg/kg IV dose, “cardiac Stable,” unclear effect if dose decreased, may not be ideal for patients in shock Propofol: 2mg/kg IV dose, shortest half-live, ideal in scenarios where neurologic exams may be required, sedation for EtOH […]

17-month-old F w/ no sig PMHx presents to the ED accompanied by her mother who is concerned because her baby is “acting drunk.” Mother reports child was staying with grandparents over the weekend and today began “walking funny and speech is slightly slurred.”  She also reports child had vomiting and diarrhea lasting for 2 days […]

  Interesting Case of Facial Swelling. 55 yo F w/ PMHx of HTN, DM, and ESRD on HD presented to the ED w/ c/o facial redness and swelling progressively worsening for 3 days. Patient  discharged 7 days prior from outside hospital but unable to attain records or d/c summary.  Last H/D 1 day prior. No […]

Most toxic mushroom ingestions simply result in abdominal cramping, nausea/vomiting and diarrhea.  But beware of amatoxin-containing mushrooms appropriately termed the “deadly white Amanitas” (i.e. A. phalloides (figure 1), A. bisporigera (Figure 2)). Suspect amatoxin ingestion in a patient with an appropriate history and (if you’re lucky) the mushroom in question.  Patients with amatoxin ingestion will experience acute gastroenteritis […]

Here are the highlights from the 2012 ACEP Clinical Policy regarding Critical Issues in the Initial Evaluation and Management of Patients Presenting to the ED in Early Pregnancy: The initial quantitative BhCG level does not help to distinguish among unspecified abortion (i.e. threatened abortion), normal intrauterine pregnancy, and ectopic pregnancy.  Therefore, the discriminatory threshold is no […]

This may be surprising to many of you, but some of our patients abuse medication.  In addition to Dilaudid, morphine, and Percocet, lets add topical ophthalmic anesthetics such as tetracaine to our “red flag” list.  The most common offenders are young male manual laborers particularly those involved in welding and foundry. Even when diluted, topical […]