Think just because you are a young, healthy physician that you are invinceable? Read this post and remember that we are vulnerable too...even more so because we often refuse to acknowledge when we are sick. This week's Advanced Practice topic comes to us courtesy of a Cooper EM alum. The story is told with full permission from the patient, his wife, though names are omitted to prevent any possible HIPPA entanglements!
Do you routinely perform large volume (or near large volume) paracentesis in your ED? If so, you need to know about a potentially life-threatening complication of this procedure...
A 34 year old Vietnamese male presents with complaint of neck swelling. It began one month ago and worsened over the past few days. He endorses fatigue and a mild weight loss. Exam shows an indurated, non mobile mass without tenderness or erythema. You order imaging and are concerned for TB but unsure what to do next.
For some, this topic may be more bread and butter than others. Many of you may work in cold areas where you are likely to see patients with hypothermia on a regular basis, especially in the winter. Whether you work shifts in a mountainous region or are simply catching up on EM topics while studying for boards in your in you flip flops by the beach, here are a few pearls regarding patients who present with hypothermia and their management.
You have made the diagnosis of disseminated gonococcal infection in your patient presenting with history and physical exam findings suggestive of purulent arthritis, now what? Treatment for gonococcal arthritis goes beyond the one-time "shot and a pill" given for uncomplicataed gonococcal infections. A quick review of disseminated gonococcal infection:
25-35% of patients with chronic liver disease with experience variceal bleeding. This post is designed to provide high-yield pearls in the evaluation and acute management of variceal bleeding.