A 70 year old female presents for hypoxia and altered mental status. On arrival she is tachycardic to 120, febrile to 38.5, hypoxic to 86% on room air, and is normotensive. She appears ill and confused. She has diffuse rhonchi throughout all lung fields. She has no significant past medical history. A workup is obtained …
An 8-day-old female presents to the emergency department with productive cough and worsening discharge from the left eye for two days. The patient’s mother also reported nasal congestion, cough, and wheezing. The patient had recently been evaluated 1 day prior in an ED and diagnosed with left lacrimal duct obstruction. At that time, no purulent …
I’ve fallen in love with a particular technique for shoulder reduction that allows the patient to self reduce. This minimizes pain experienced during the procedure as well as avoids the need for conscious sedation. I call it the modified Boss-Holzach-Matter maneuver, or the Boss Stokes maneuver (because I couldn’t think of anything witty to do with …
A 47 year-old male presents to the emergency department reporting 3 days of intermittent chest discomfort, palpitations, diarrhea, vomiting, and malaise. He has a past medical history significant for atrial fibrillation and “thyroid problems.” He states that he stopped taking all of his medications about a month ago for an unknown reason. On arrival in …
A 2 year old male presented to the ED for groin swelling. His mom stated that everything started with a viral illness 2 weeks ago, which then progressed into multiple areas of swollen joints associated with pain and the inability to walk. One day prior to presentation a red, non painful rash appeared on his …
A 23 y.o male presents with worsening sore throat, dysphagia, and cough over the last 3 days. On exam, patient is in no acute distress but is tachycardic. Patient is able to speak in full sentences, has no stridor at rest, and is handling secretions. The patient’s oropharynx has notable erythema and swelling in the …
Continue reading Bread and Butter EM – Peritonsillar Abscess
Poisonings with methanol, ethylene glycol, and isopropanol often present the emergency physician with major diagnostic challenges: The identity of the ingested substance is frequently a mystery on presentation. Patients with an intentional ingestion, either for recreation or with suicidal intent, may be less than forthcoming. Young patients may not be able to identify the substance. Patients may be …
In the ED we are often concerned about the pH, CO2 level, and oxygen saturation of patients. How does one determine whether to get a venous blood gas (VBG) or arterial blood gas (ABG)? ABGs are typically seen as the “gold standard” for evaluating pH, PaCO2, and HCO3 but in certain situations VBGs are a …
A 59 y.o m with a hx of bipolar on wellbutrin and paxil presents with altered mental status. On exam he is found to be tachycardic, hypertensive, diaphoretic, and flushed. He has a fever to 38.1. He has clonus on exam as well as hyperreflexia and rigidity in his bilateral lower extremities. He requires intubation …
It’s a little after midnight when a middle aged male walks into the ED complaining of chest pain. The triage nurse immediately grabs you because she’s concerned about the way the patient looks. You walk into the room and see a man with mild diaphoresis and stable vitals. He mentions he started having pain in …
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