By Baruch Berzon MD and Richard Sinert MD Case Presentation A 32 year-old male presents in August to EMS with complaints of “flutter in my chest” and light-headedness for an hour. The paramedics find a young man in mild distress who is Diaphoretic with a heart rate of 220 and Read more…
Written by: Raymond Beyda For the non-emergent, non-ketotic, non-acidotic, uncontrolled hyperglycemic… Case: A 47 yo M h/o DM with frequent ED visits presents feeling dizzy and lightheaded x 3 days. ROS is positive for polyuria and polydipsia. Vital signs are within the normal range, his exam is unremarkable. Imaging is negative. Read more…
A CASE: A 40 y/o black homeless man presents with difficulty walking secondary to extreme left lower extremity pain. On exam, the patient is afebrile, HR 105, RR 20, BP 120/65. His extremity is swollen, warm, erythematous and extremely tender to touch. A sepsis code is called; the patient is Read more…
A 25 y/o smoker presents to the ED with SOB and tells you her asthma is acting up. You think to yourself, “I love the crashing asthma patient!” Within 5 minutes bipap is bedside, solumedrol is given and somehow she’s already on her 3rd round of combinebs. “Nailed it!”
She’s feeling pretty good now and breathing better. The room’s starting to get chaotic, but you’re a good doctor so you make sure to write her scripts for a course of oral corticosteroids and you even remember to say, “see your doctor in the next week” as she signs the discharge papers. Job well done!… right?
There are soooooooo many things missing here it hurts. Sure the course of steroids will cool everything off for a few more days, but what about a week from now when she’s back chain-smoking with her buds? Does she have albuterol at home? Is she going to see her PMD? Does she have a PMD??? Well you can ask her in 2 weeks when she comes back. (Catch my point?)
Controller versus Rescue medications (more…)