Abscess: After incision and drainage, do you pack or not? What does the literature say?
An elderly man presents to the ED after falling down a flight of stairs at home. He has mild but worsening dementia and his wife called EMS when he couldn’t stand up from the fall. Your patient still does his own ADLs but is progressively forgetting things, like where he put his keys and to […]
A young woman precipitously delivers a 34wk gestation neonate in your ED. The mother is physically doing well and you turn your attention to the neonate, whose HR is 105 but falling. You prepare for a possible neonatal intubation and alert the NICU. Peds is on the way and you begin your resuscitation of the […]
We are pleased to present our annual critical care ultrasound pre-conference course at the Clinical Decision Making in Emergency Medicine symposium in Ponte Vedra, Florida on Wednesday, June 20. Each year this intensive, hands on course features ultrasound faculty from across the country working in small groups with live models and plenty of hands-on scanning […]
A 6yoM is brought by his guardian for intermittent crying, c/o abd pain for the past two days; he has vomited 4times over the past 2days. He has had no fever and has never had anything like this before. At home his urine has been dark, and this morning, possibly bloody. He has no medical […]
Early in the morning, a young man p/w R-great toe pain after having his foot stepped on while dancing last night (a few hours ago). On exam, you appreciate full ROM and strength but your patient is pretty uncomfortable. He took paracetamol and ibuprofen at home with minimal relief. There are no signs of infection […]
Emergency physician, intensivist, and Mount Sinai Emergency Ultrasound Fellowship graduate Dr. Robert Arntfield is making news at his new home, London Health Sciences Center (LHSC) in Ontario, Canada. Dr. Arntfield and his department have set up a hardware and software infrastructure for bedside ultrasound which allows for electronic data storage and retrieval, robust QA, teaching […]
Today’s pearl is courtesy of the AM report. When evaluating the lethargic pediatric patient there’s lots to consider. Here’s a mnemonic, that if you can remember it (write it down) could be elucidating. Carbon monoxide poisoning Overdose Metabolic derangement/disorder Abuse/alcohol/asphyxia Trauma Organic acidosis (that’s metabolic d/o again) Seizure/shock Encephalopathy Psychiatric disturbance Acidosis/alkalosis Tumor Insulin/intussusception Endocrine […]
A 55yoM is BIBEMS after an MVC c/o RLE pain w/obvious deformity at the thigh. Distally he is NVI but is in excruciating pain. The portable plain film shows a mid shaft fracture. You order dilaudid but he’s still really uncomfortable. How can you help him?
A pleasant 64yoM w/NIDDM and afib (on coumadin) p/w an abscess to R-medial thigh. He is afeb but there is some surrounding erythema at the abscess site. You perform a thorough incision and drainage and instruct him to return in 2days for wound check; he is discharged with bactrim DS 2tabs BID for 10days. He […]
