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…
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…
You are just getting over your third viral illness this winter. Your tummy will never forget this one, but on the bright side you lost 5 pounds nibbling on saltine crackers for a week. You drink some coffee and coconut water in a hurry and arrive energized to your shift Read more…
It is a quiet morning in the ED. I know it’s difficult to believe. The triage nurse rolls in a young patient who is screaming in pain. “Doc, doc, my n@&* are killing me!” You can’t help but start thinking about a differential diagnosis on your way to interview your Read more…
An overview of Huang, DT et al. (2018). Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med, 379(3), pp.236-249 https://www.ncbi.nlm.nih.gov/pubmed/29781385 Background: Procalcitonin is an acute phase reactant used to differentiate bacterial from viral infections. Previous Read more…
In 2001, the only drug to treat sepsis was approved by the FDA and swiftly brought to market by Eli Lilly & Co. So, why have most residents never heard of Xigris (drotrecogin alfa)? By Dr. Lee Grodin [1] Bloomberg News. Lilly Read more…
Emergency departments everywhere are dealing with a surge of patients due to the influenza pandemic. During a recent shift, you pick up your 6th triage complaint of “I have the flu.” You send the medical student to go see the patient, and she returns an hour later with an extensive Read more…
We had three wonderful answers to last month’s COTM, but Dr. Segarra’s comprehensive response takes the cake. For a complete review of the case, please click here. Just to recap: 50-year-old woman with DM2, HTN, GERD, recently completed 6 months of TB therapy, presented with abdominal pain, N/V, Read more…
A 2-year-old boy is brought to the ED by his mother for persistent fevers. The mother says her child has been having high fevers of 102-103 for the past 4-5 days. He was seen at another hospital earlier in the course and was told it was likely a viral syndrome. He Read more…
An unknown young male makes his way into the critical care area of your emergency department on a boring night. He is minimally responsive and is breathing at a very slow rate. You look at his pupils, and they are pinpoint. You see track marks up and down his arms. Read more…