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!Read more
Submitted by Laura Di Taranti, MD
There is a seemingly endless number of inborn errors of metabolism, and many of these children can present acutely to the emergency room. As emergency medicine physicians, we may not be experts in each of these diseases - but we still need to know how to resuscitate and care for these patients. Below is a general outline on how to approach most inborn errors of metabolism and general guidelines for resuscitation (besides the usual ABCs, IV, O2, monitor).Read more
Submitted by Katherine Billings MD
As the number of COVID-19 cases rises drastically and the global pandemic continues to change life as we know it, we are all hoping for news of effective treatment. Approximately 15 percent of patients infected with SARS-CoV-2 develop pneumonia requiring supplemental oxygen and an additional 5 percent progress to critical illness and acute hypoxemic respiratory failure. Although numerous drugs have been investigated, only dexamethasone has demonstrated improved survival in patients hospitalized with COVID-19 in a randomized controlled trial design. We now have data from 3 randomized controlled trials to guide the use of remdesivir for severe COVID-19.
Submitted by Emily Murphy, MD
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....Read more
Submitted by Sandhya Ashokkumar, MD