Most patients presenting to the ED with a headache have a simple primary headache: tension, migraine, or cluster. Detecting the "other" etiolgies for headache, which can result in neurologic devastation or death, is often a diagnostic challenge. He we give some quick hits for one of the "can't miss" headaches, how it presents, and how to diagnose it.
Read moreSubmitted by Richard Byrne, MD
Unstable bradycardia? Complete heart block? No worries - we've got you covered with this pictoral guide of how to place a transvenous pacer.
Read moreSubmitted by Alexis Pelletier-Bui, MD
Venous thromboembolism is considered one of the most preventable causes of in-hospital death. Venovenous extracorporeal membrane oxygenation (VV ECMO) utilization for severe respiratory failure has increased in the decade following the 2009 influenza A H1N1 pandemic and the publication of the CESAR trial.1 The interaction between a patient’s blood and the ECMO circuit produces an inflammatory response that can provoke both thrombotic and bleeding complications. In a systematic review of patients with H1N1 treated with VV ECMO published in 2013, the incidence of cannula-associated deep venous thrombosis (CaDVT) was estimated to be as low as 10 percent; however, more recent data suggests the incidence of venous thrombosis after decannulation is much higher. Additionally, a significant proportion of CaDVT are distal thrombi located in the vena cava, which would be missed with a traditional ultrasound diagnostic approach after decannulation from VV ECMO.
Read moreSubmitted by Emily Damuth, MD
Your patient appears intoxicated but their ethanol level is ZERO ... think toxic alcohols
Read moreSubmitted by Loran Hatch, DO
A 61 yo female with a history of DM presents with 3 days of severe R ear pain.
Read moreSubmitted by Jillian Smith MD
A 55 year old male presents to the ED with complaints of anterior chest pain radiating through to the thoracic area X 2 days...you mentally run through a check list of the potential "red flag" signs/symptoms for serious back pain before you enter the room. Will this be another benign musculoskeletal pain or something more sinister?
Read moreSubmitted by Richard Byrne, MD
Review the basics of local anesthetic systemic toxicity. Make it L.A.S.T. in your memory!
Read moreSubmitted by Lynn Manganiello, DO
A 68 year old male with a history of a right ankle ORIF three weeks ago is transferred to your ICU for management of a pulmonary embolism. He developed acute dyspnea while at physical therapy and was taken to an ED where he was found to have bilateral pulmonary emboli extending into both segmental and subsegmental pulmonary arteries on CTPE. His workup included elevated troponins and an echocardiogram that showed a dilated RV with hypokinesis of the RV free wall and reduced tricuspid valve annular systolic excursion. He was started on a heparin infusion prior to transport and was hemodynamically stable when you took the transfer call. When he arrived to your facility he was mentating well but his BP was 85/50 with a HR of 115 and an spO2 of 96% on 2L NC. How will you address his hypotension?
Read moreSubmitted by Tom Sewatsky, MD