Richard Byrne, MD

Critical Cases - Thyrotoxic Periodic Paralysis

A healthy 30 yo male p/w cc of generalized weakness and pain for several hours. But generalized weakness and pain can be about 2 million things! you bemoan internally as you sign up for the patient. Hang on, what's this? Admitted previously for severe, unexplained hypokalemia? The plot has thickened....

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Critical Cases - CO and Cyanide toxicity!

EMS calls ahead to report a 73 yo female with active CPR in progress after being pulled from a housefire. As you run to prepare you resus room, you wrack your brain for everything you know about smoke inhalation victims. Aren't there some toxicology concerns here? Good thing you read this quick refresher on EMDaily!

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Critical Cases - Methemoglobinemia!

An intubated 32 year old female is brought to the ED in cardiac arrest. Family was suspecting that this was an overdose.\ given a recent hospitalization for acetaminophen overdose. EMS reports that on arrival the patient had a bluish discoloration to the skin, and she is now extrememly pale with the appearance of a cadaver. What could have caused this clinical picture? Read on for a discussion of a very rare but extremely deadly poisoning...

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Critical Cases - Phenytoin overdose!!!

A 55 year old patient presents via EMS reporting a large ingestion of his home oral phenytoin. As you go to evaluate the patient, you consider the clinical manifestations and possible complications of a phenytoin overdose. Is this a serious overdose? Is there a high potential for decompensation and the dreaded tox "seizure/coma/death" triad? Are there effective antidotes? Good thing you read this article!

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Critical Cases - Spine Emergency!

Back pain. A chief complaint generally not considered among the top 5 most thrilling for EM docs. Hiding among a sea of benign musculoskeletal conditions, however, lurk a handful of diagnoses which will result in irreversible paralysis and severe loss of function for our patients. The trick, of course, is figuring out who needs expensive advanced imaging and who can go home with NSAIDS....read on for a case that definitely falls into the former category....

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Critical Cases - Hypertensive Encephalopathy!

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...

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Critical Cases - Cor Pulmonale Emergency!

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!)

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Critical Cases - New Onset Afib with High Output Heart Failure!

History

  • 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 

ROS

  • Positive for dyspnea, palpitation
  • Positive for abdominal distention, which she attributes to constipation

PMHx

  • Moderate intermittent asthma on albuterol PRN 

Physical Exam

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Critical Procedures: How to Create a Pericardiocentesis Model

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

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