Quick case: It’s 3am. A 55yM, with a pmhx of chubbiness, DM, HTN is brought in by EMS after being found down. He is pulse-less, with an initial rhythm of ventricular fibrillation. He is shocked appropriately and exquisite ACLS is performed. He regains pulses 20 minutes after EMS arrival…Now Read more…
The Case 75 yo female, multiple medical problems presents with subjective fever/cough for 2 days. Work-up shows – nml VS, lactate 1 and left lower lobe infiltrate. Unfortunately she’s CURB-65 of 2 (age and BUN) with PORT score of 95. More importantly she lives by herself and doesn’t seem altogether Read more…
The debate on the treatment of circulatory shock is over(-ish?). Ever since the NEJM put out its big RCT on the treatment of all-comer shock[i], we know that norepinephrine is the vasopressor of choice. Septic, cardiogenic….doesn’t matter. Norepinephrine is superior to dopamine. Bummer, right? Choice of vasoactive agent was so Read more…
The Case So the radiology resident says to me in disbelief, “you want another lower extremity Doppler when this patient had a negative study 2 weeks ago?” I answered, “Yes. A single one does not rule out DVT.” He asked me where I got that fact, and unfortunately, I could Read more…
What is it good for? Something? Maybe? Remember in medical school when the right answer to everything was cytokines. The mythical inflammatory response; all those interleukins, TNFs, and all other forms of molecular magic that drive our response to infection. The so-called “pyrogens,” or molecular agents causing fever, are Read more…
ED Critical Care Conference: Sept 2013 The Curious Case of AMS with an (initially) Normal CT Head presented by Dr. Andy Grock Case: 24 yo M, no pmhx presents AMS s/p assault. MRI shows Diffuse Axonal Injury. TBI Discussion Severity by GCS Mild >13 Moderate >9 and <12 Severe <8 Read more…
It’s a busy shift in good old A pod. A nurse comes up to you with a bag of blood tubes for a vomiting patient and asks if you want to shotgun labs and give some anti-emetics. You happily oblige, ordering a liter of normal saline, Zofran, and some labs. Read more…
Thanks for all the responses! Here is short version of the answer for those of you with ADD. Keep on reading for the details! Our patient had sick sinus syndrome with a sinus bradycardia on top of her malfunctioning pacemaker. She was admitted to medicine for CHF exacerbation. The inpatient team Read more…
EM-Critical Care Conference: August 2013 PULMONARY EMBOLISM Summary by Dr. Eugene Kang Diagnosis and EKG: -Most common EKG finding: non-specific ST-T changes (at least for our boards) -Other findings: sinus tachycardia, complete or incomplete RBBB, RAD, right atrial enlargement, dominant R in V1, atrial tachyarrhythmias -Some likelihood ratios (see Read more…
So for this post… we’re going to combine some EKG action with some good ole’ CXR reading… Since we’re not just doing Rhythm Nation or X-ray Vision… we’re going to call it Rhythm Vision! Here’s the case: Your patient is little old granny, an 85 year old woman with a Read more…