Richard Byrne, MD

Critical Cases - Ankle dislocation!!

It's an ice storm in South Jersey! Thirty-four (34!) patients present within 4 hours with slip and falls and a veritable menagerie of orthopedic injuries. You see a 29 yo male who everted his ankle on the sidewalk. There is an obvious deformity. Should we order an xray and then call the orthopedics resident? No! We're going to reduce, splint, and discharge this patient ourselves....

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Critical cases - Digoxin toxicity!

An elderly female arrives complaining of fatigue and weakness (easy right?) and a casual glance at the MAR shows the she is on digoxin for CHF. You notice she has a HR in the 50s and wonder if digoxin toxicity could be repsonsible for her symptoms. Lucky for you, you brushed up on this basics with this quick case review!

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Critical Cases - Swollen 2 year old!

A 2 yo female presentes with parents with complaints of "whole body swelling" noted over days. You panic slightly as you reach for possible differentia diagnoses to explain this perplexing symptom and are struck by a distant memory of your peds rotation from medical school, or perhaps a flash of a memory staring at your Robbins textbook of pathophysiology.....

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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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