Tue, 08/11/2020 - 5:12pm

A patient is brought in by EMS in severe respiratory distress, though o2 sats are normal and lungs are clear on auscultation. You wonder what is triggering the patient's severe tachypnea as you contemplate intubation....

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Mon, 08/10/2020 - 5:00am

Delivering bad news, such as concern for a new cancer diagnosis, is difficult in any setting. In the ED, we are often faced with additional challenges - limited information, time constraints, lack of established relationship with patients, and many others. Yet it is crucial we learn to do this well - here is some guidance to get started.

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Sat, 08/08/2020 - 2:00pm

A 21 year old oth

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Fri, 08/07/2020 - 3:00am

You admitted a 72 year old male to the ICU for septic shock from community acquired pneumonia. He required intubation and mechanical ventilation for failure to improve oxygenation with NIPPV and encephalopathy. He received broad spectrum antibiotics and a 30 cc/kg crystalloid bolus. His MAP was persistently in the 50s despite adequate fluid resuscitation and based on your exam he does not appear hypovolemic. Norepinephrine is started and despite adequate MAP he is oliguric. His only medical history is he was a previous smoker with COPD, HTN, HLD but normal renal function with a Cr of 0.8 two months prior. His Cr on admission is 2.2 and a foley is placed and his UA shows granular casts. He is not acidotic and his electrolytes are normal. 

You are concerned this patient is heading towards renal replacement therapy. He is adequately fluid resuscitated and has a MAP above 65 on a vasopressor but is still not making urine and has signs of ATN on urinalysis. Renal replacement therapy is an invasive procedure and has associated risks. If a patient has a chance to have renal recovery with a more conservative approach then this should be considered.  You wonder if there is a diagnostic test which can be used to assess the potential for renal recovery.

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Thu, 08/06/2020 - 6:00am

Some highlights from Dr. Sunip Patel's lectures on Electrical Injuries 

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Wed, 08/05/2020 - 7:00am

A 4 yo M presents to Urgent Care with R shoulder pain after a fall off his bed. Father denies any head trauma or other injury. On exam, he has decreased ROM at the R shoulder and tenderness and ecchymosis along the distal/mid clavicle. Neurovascular exam is normal.

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Tue, 08/04/2020 - 10:16am

The overwhelming majority of patients with back pain have a benign etiology and require nothing more than pain control and time to recover fully. A good emergency medicine physician, however, should always keep in mind the "can't miss" diagnoses and take a careful history focusing on "red flag" symptoms and risk factors. Failure to make the diagnosis in our patient today would result in irreversable paraparesis, incontinence, and impotence. Read on to see why!

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Mon, 08/03/2020 - 5:00am

Good analgesia is crucial in fracture reduction. This can be achieved many different ways, including regional anesthesia, systemic pain medications, or procedural sedation.  For certain fracture types, such as wrist fractures, a hematoma block is often used.  Here are basic instructions, tips and tricks for performing a hematoma block.

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Sat, 08/01/2020 - 10:00pm

19-year-old male

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Fri, 07/31/2020 - 4:00am

A 34-year-old woman at 32 weeks gestation presents to the emergency department with cough, dyspnea and hypoxemia. She rapidly progresses to severe ARDS despite lung protective ventilation, paralysis and inhaled epoprostenol. P/F ratio is 99 mm Hg. Is prone positioning safe to perform in pregnant patients with severe ARDS? If so, are modifications necessary to offload the abdomen and monitor the fetus? A recently published review in Obstetrics and Gynecology discusses this important topic. 

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