Richard Byrne, MD

Critical Cases - Acetaminophen Induced Methemoglobinemia!

A 32 yo male suffering from dental pain for the past several days presents to the ED complaining of abdominal pain. He notes ingesting large quantities of acetaminophen for the pain. Your triage nurse notes he is hypoxic on RA at 86%, but oddly this does not rise when the patient is placed on oxygen....

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Critical Cases - Pulmonary Edema and Afib!

A 63 year old male arrives via EMS in acute respiratory distress. Medics note he is in atrial fibrillation with a heart rate in the 150s. You ponder the age old question as you walk to the resuscitation bay: "Is the high heart rate causing the respiratory distress or vice versa?"

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Critical Cases - Serious Headaches and Where to Find Them

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.

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An Alternative Abortive Therapy in Refractory Trigeminal Neuralgia Pain Crisis

A 34 yo female with a history of trigeminal neuralgia presented to the Emergency Department with a chief complaint of 5 days of severe, worsening paroxysms of pain in the left trigeminal nerve distribution. The pain was refractory to carbamazepine and gabapentin. Neurology was consulted and an unconventional therapy was recommended.

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Critical Cases - Post LP Subdural Hematoma!

A 24 year old female presents to the ED complaining of a worsening headache after a lumbar puncture performed in the ED 2 days prior which diagnosed idiopathic intracranial hypertension. "No problem!" you think. Either this is just a post LP headache or possibly the patient needs more CSF drained to improve her headache. LP is a very safe procedure with minimal risk after all! Right?

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Critical Cases - Severely agitated DKA patient!

A 23 yo male with a hx of insulin dependent diabetes and recurrent admissions for DKA presents to the ED with complaints of diffuse body aches. He is acutely ill appearing, agitated, and combative with staff, demanding pain medication, entering other patients rooms, and screaming. Realizing that this patient is severely ill, you wonder how you will de-escalate or sedate this patient safely to enable life-saving care to be rendered.....

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Advanced Practice - Calcific Tendonitis Can Mimic Septic Arthritis!

A 63 yo male presents complaining of severe pain to the right shoulder. He has markedly restricted range of motion in the shoulder, without any overlying erythema, edema, or warmth. You take a cursory glance at the xray as you gather supplies to perform an arthrocentesis for suspected septic arthritis...

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