An in-depth analysis of current topics in Emergency Medicine and Critical Care Medicine typically based upon our regular EM-CCM conference.
A 40-year-old male with a past medical history of paraplegia presents with four days of right thigh swelling. He initially noticed a small ulcer on his thigh and tried home treatments with alcohol swabs and peroxide rinses. He reports worsening swelling and pain from the area and also notes hematuria, Read more…
Kudos to Dr. Beth Hanson. One of our recently graduated fourth-year residents, who will be an attending in Colorado, went above and beyond the call of duty just a few weeks ago. Dr. Aleksandr Gleyzer nominated Dr. Hanson for acknowledgment. It was a relatively busy CCT shift when Dr. Hanson Read more…
Diabetic ketoacidosis (DKA) is seen so often in our ED we may take the diagnosis and treatment for granted. Just follow the numbers – potassium 3.5, glucose 250, insulin drip at 0.1 U/kg/hr. But it helps to understand the underlying pathophysiology, because this can help you form a more nuanced Read more…
A 54-year-old male with history of alcohol abuse presents with right forearm pain and swelling following a fall two days ago. The pain is constant, sharp, “radio buzzing”, and 10/10. He also reports redness, swelling, and “feels cold”. He denies fevers, LOC, CP, SOB, weakness/numbness. Initial VS: HR 120/min, RR 20/min, Read more…
As you sit down at your workstation to finally catch up on some of those notes you’ve been putting off until the end of your shift, one of the nurses comes to notify you… “You remember that patient in room 4 with the leg pain? This is her urine…” You Read more…
Background 2017 AHA/ACC guidelines for the treatment of hemodynamically stable patients with ventricular tachycardia (VT) include the following recommendations:1 Intravenous procainamide can be useful to terminate VT. (Class IIa) Intravenous amiodarone or sotalol may be considered to terminate VT. (Class IIb) In 2013, deSouza et al conducted a systematic literature Read more…
This article will not attempt to wade into the pathophysiology of acid-base disorders. From reading the nephrology literature, it seems that this topic is more closely akin to theoretical physics than the sturdy biochemistry I learned in college. Researchers can’t even agree on how to define acidosis, much less what Read more…
We are all going to get this notification at some point. You’ll be wandering around the ED doing lunges out of boredom, and the phone will ring …. “61-year-old male found down in VF, shocked x 3 without ROSC, intubated, IV access, epi x 3, amio. ETA 5 minutes.” …You’ll Read more…
It’s 2:00 am in the Main ED and you’re racing to get caught up on the board when a nurse comes to notify you about a patient who is still waiting to be seen. A quick glance at the triage chief complaint reads “Cough and fevers x 2 days.” The Read more…
by Sana Kathawala, MD MBA It’s a quiet day in the ED. You’re twiddling your thumbs wondering whether you should get a second cup of coffee to keep awake when the notification phone rings. “68-year-old male with history of diabetes, hypertension, and ESRD with witnessed syncope after hemodialysis earlier today. Read more…