A 44-year-old man with a history of cardiac arrest complicated by hypoxic-ischemic encephalopathy presents to the ED in respiratory distress. He underwent tracheostomy 2 weeks ago for acute respiratory failure and was subsequently weaned to trach collar. He developed acute onset of respiratory distress at rehab this morning and now presents to the ED with acute hypoxic respiratory failure. On exam, he is hypertensive (169/88), tachycardic (HR 178), tachypneic with respirations assisted with bag-valve mask (BVM) ventilation and hypoxemic (SpO2 87%). What is your approach to the management of tracheostomy emergencies?
Read moreSubmitted by Emily Damuth, MD
A 2 yo female presents with fever and difficulty swallowing
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Submitted by Katie Selman, MD
A 41 yo male is brought in by EMS after self inflicted stab wounds to the neck and chest. As the patient is transferred to the ED stretcher, you frantically try to recall the initial priorities in the management of this potentially deadly injury....
Read moreSubmitted by Karen O'Brien, DO
Everyone has seen the long list of causes of an anion gap metabolic acidosis. Why review it again? Because one day, whether in real life (or on your board exams...), thinking through this list will help make a tricky diagnosis. It is 'back to basics,' after all!
Read moreSubmitted by Lynn Manganiello, DO
Physiologic alarms in the ED frequently sound without any meaningful change in patient management. Understanding the effects of unnactionable alarms and their consequences is vital for the EM physician.
Read moreSubmitted by Lars-Kristofer Peterson, MD
Is Low Dose Ketamine Comparable to Morphine in Providing Acute Pain Relief in Adults in the Emergency Department?
Read moreSubmitted by Amanda Curry, MD
A 55 yo M presents to the ED after being struck by a motor vehicle.
Read moreSubmitted by Loran Hatch, DO
A 37 year old male is brought to the ED for acute onset of confusion and agitation. He is combative and only intermittently following commands. Read on to discover the ultimate obvious, and yet cryptic, diagnosis!
Read moreSubmitted by Richard Byrne, MD
We encounter patients with upper GI bleeding frequently. While some of these are obviously ill and in need of urgent intervention and/or admission, others appear well and we might consider sending them home - but how do we decide who is low risk enough to discharge? Is there an evidence based approach to risk stratify patients with upper GI bleeds?
Read moreSubmitted by Anil Reddy, MD