Richard Byrne, MD

Critical Cases - "I drank this"

A 50 yo male is brought in via EMS vomiting red fluid. 1 hour prior, he had chugged about half a gatorade bottle that he had used to store windshield washer fluid. "What's in windshield washer fluid?" you wonder as you enter the patient's room. "Is it bad????" Read on to find out why, yes, this is very bad indeed.

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Critical Cases - Dizziness and Vomiting - Benign or Catastrophic?

A 59 year old male presents complaining of unsteadiness on his feet and vomiting for 24 hours. You know there are numerous benign explanations for his symptoms, but also realize there are a few "can't miss" diagnoses as well...what are they and how do we assess for them in the ED?

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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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Critical Cases - T Trach respiratory distress emergency!

A 56 yo male with a hx of TBI, subglottic stenosis, tracheomalacia, and tracheal stenosis presents in acute respiratory distress. There is a strange looking trach in place with no balloon for a cuff. You begin to wonder how you will manage this pt if he ultimately requires mechanical ventilation.....

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Critical Cases - Pericardial effusion!

You are evaluating a patient for abdominal pain the usual way (with a CT of course!) when you discover an incidental pericardial effusion. Quick as a flash you grab your trusty ultrasound and head back to the patient's room, wondering how this effusion got there and what POCUS findings you should be looking for...

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Critical Cases - Hyperkalemia Emergency!

A 56 year old male presents to the ED with confusion and abdominal pain. You notice a fistula in his upper extremity. A tech hands you his triage ECG and you scrutinize it for the tell-tale signs of a common, life-threatening diagnosis in hemodialysis patients, while wondering what the initial steps in management are....

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Critical Cases - Refractory SVT in the ED!

You are evaluating a patient with the sudden onset of palpitations. You note a regular, narrow complex tachycardia at a rate of 160 bpm and suspect a reentrant tachycardia. You think "adenosine" but secretly wonder if there is a better option, or what you'll do if this fails....

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