You receive a prehospital stroke alert from ALS for a 73 yo male found down, minimally responsive. "Pretty routine" you think as you listen to report from the paramedic...that is, until you hear the vital signs: "Blood pressure is 270 over 140." That's the highest blood pressure you've ever heard of and you immediately begin to worry about how the human brain can possibly tolerate this as you head to the resuscitation bay to assemble your team...
Your nurse approaches you and says there is a new patient who arrived via EMS with shortness of breath. And his o2 sat is 65% on nasal canula. That gets you out of your chair and into the room in a hurry and you wrack your brain for the various causes of acute onset hypoxia as you enter the room (and no, it's not Covid-19!)
- 49 yo F pHx asthma presents ED with worsening DOE for the last month acutely worsening today
- No prior hospitalizations or intubations for asthma exacerbation
- Positive for dyspnea, palpitation
- Positive for abdominal distention, which she attributes to constipation
- Moderate intermittent asthma on albuterol PRN
Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818
EM physicians see patients with headaches every day in the ED. The vast majority have a simple primary headache, but a tiny fraction of patients will have a much more serious etiology that might result in death, blindeness, or crippling neurologic complications if not promptly diagnosed. The trick, of course, is picking up on the serious causes of headaches...
A 69 year old man is brought in by EMS with complaints of chest pain. ALS noted pt to be in sinus bradycardia in the 30s en route. As you approach the room you wrack your brain: what are the common causes of bradycardia? More importantly - will I get to actually perform a transvenous pacemaker i.e. the most highly sought after procedure as an emergency medicine resident?
History: A 64-year-old woman presents to the ED via EMS after a witnessed seizure lasting less than 1 minute. The patient appeared post-ictal for EMS but is currently alert and oriented. She does not recall what happened.
An 87 yo male is brought in by EMS after a syncopal event while on the toilet, resulting in a fall and head injury. EMS reports a heart rate in the 30s en route. As your approach the resuscitation bay you begin to think about the causes of bradycardia and what your approach will be to stabilize this potentially very sick patient....
You are called to the trauma bay to evaluate an 18 yo male involved in an MVC. Your nurse tells you that he seems ok but keeps repeating himself. You wonder what injuries you should be concerned for and what your diagnostic approach should be as you enter the patient's room.....