April Fools Morning report (4/1/16) 3 case topics that will FOOL you Case 11 A 45 year-old man presented to the hospital with chest pain and dyspnea. Exam was unremarkable. ECG showed T-wave inversions in leads II, III, aVF, V1-V4, and troponin was elevated. He was pale, diaphoretic, tachycardic, with Read more…
It’s a busy night shift when a nurse alerts you to an elderly patient sent from a nursing home who is hypotensive, tachycardic, tachypneic, febrile, altered, and appears dehydrated. You assume sepsis, send labs, begin treating empirically with broad spectrum antibiotics, and start fluid resuscitating the patient. Despite receiving 30cc/kg of normal Read more…
The Case 58 year-old man with history of mitral valve prolapse presents with 4 days of intermittent palpitations, lightheadedness, and shortness of breath. The symptoms resolve spontaneously. He denies any illicit substance use. Vital signs on arrival: T 97.5F, HR 71, BP 140/89, RR 18, SpO2 100% on room air. Read more…
Chest pain: Cause for more than 8k…no, 80k…no, 8 MILLION visits!! What this is about? -Not the 60 year-old sweaty guy with crushing chest pain, ST-Elevations, and trop of 4000 (How many of those do you see?) -Not the 18 year-old girl elbowed in the chest, now with a bruise, Read more…
A 29-year-old male comes to your ED complaining of pressure-like left sided chest pain that started an hour after he smoked marijuana. He has never felt anything like this before. He has no medical problems, surgeries, medications, allergies, and has no family history of heart disease. He does not smoke cigarettes, Read more…
Hello everyone! I’d like to start off by saying it’s an honor to contribute to this amazing group! I am one of three pharmacy residents at SUNY Downstate Medical Center and have had the opportunity of working with some of you at UHB. Starting this month, I will be posting Read more…
Here’s Dr. Carmelli with today’s Morning Report! Dextrocardia and Situs Inversus Definitions Situs solitus: Normal position of organs/structures Situs inversus: Opposite or reverse of normal position of organs/structures Levocardia: Cardiac apex pointing to the left Dextrocardia: Cardiac apex pointing toward the right Cardiac displacement: A secondary shift of heart Read more…
The EKG is an integral diagnostic tool in EM let alone the whole of medicine. It is a rapid, reliable and cost-effective method to aid in the diagnosis of cardiac pathology including ischemic and arrhythmic events. So how did it come about? The 12 lead EKG was innovated via multiple Read more…
Thanks to Dr. Kopping for presenting today’s Morning Report! Digoxin Toxicity Digoxin falls under cardioactive steroids Fox glove, oleander, dried toad secretions Na/K ATPase inhibition Resting potential more positive, more likely to depolarize Increases inotropy by preventing Ca leaving cell via Na/Ca channel Increases automaticity Narrow therapeutic window Poisoning Read more…
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…