Core Emergency Medicine

This post discusses the uncommon but important to recognize subtalar dislocation

This post discusses tips for diagnosis of MetHb and pearls for management.

Core Podcast See More →

This week we discuss the tibio-femoral knee dislocation focusing on identification of the dangerous complications.

This week we dive into the diagnosis and management of pancreatitis in the ED

Core Procedures See More →

This is a brief video detailing how to do regional anesthesia for the fingers.

Read more

This post discusses the application of both a commercial pelvic binder as well as a sheet for pelvic stabilization.

Read more

Core Blog See More →


The Paradox

“Go take a break.” “Let me quickly pick up these two patients.” “Go grab some food and come back.” “I’m fine, I’ll just…” “Sanjay, get the hell out and don’t come back for fifteen minutes.”

It was my sixth overnight in a row. After having struggled for over 15 minutes with trying to place an ultrasound guided IV in a sickle cell patient,
Read More


Teaching on a clinical shift can sometimes be difficult: it’s busy, everyone’s running around and it’s hard to capture a trainees attention. Recently, on twitter, Amal Mattu (@amalmattu) has been posting pictures of his white board teaching: discrete pearls written down and shared with anyone who walks by. The pearls are often prompted by patients presenting during that shift but they don’t have to be.
Read More


The MDCalc Fellows program is a 2-year longitudinal engagement for residents and medical students passionate about EBM and knowledge translation. 
Read More

Core Journal Club See More →


Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study Lancet, 2017


The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing.
Read More


Variability in Interpretation of Cardiac Standstill Among Physician Sonographers Ann Emerg Med, 2017

Point of Care Ultrasound (POCUS) has gained wider use in resuscitation of patients presenting with cardiac arrest. POCUS can play an important role in determining the etiology of arrest as well as being used to determine the presence or absence of mechanical activity.
Read More

Core Case of the Month More Cases →


Shortness of breath and abdominal pain


62yM PMH HTN, HLD, DM2, bioprosthetic MVR p/w shortness of breath and diffuse abdominal pain for three days. He c/o generalized malaise, nausea and multiple episodes of non-bloody, non-bilious emesis. He is concerned about elevated readings on his home glucometer. He is prescribed lisinopril, metoprolol, metformin and lantus. He denies alcohol or drug use. Denies fevers, chills, chest pain, palpitations, dizziness, diarrhea, dysuria, or recent trauma.

Physical Exam

132/91 – 94 – 40 – 100% – 97.0
Ill appearing, in moderate distress, moaning and breathing heavily, speaking in short sentences
Neck supple, no JVD
Borderline tachycardic, no murmurs, rubs, gallops; distal pulses intact
Tachypneic, CTAB
Abd soft, nondistended, diffusely tender to palpation, no pulsatile mass, no rebound or guarding
Ext warm, no edema
Skin dry
Awake, alert, moving all extremities spontaneously


VBG: pH 6.818, pCO2 25.7, pO2 65.7, HCO3 3.9, Lactate 22
CBC: 8.8 > 8.9 / 27.5 < 167, 84% PMN BMP: 146 / 5.9 / 89 / <10 / 48 / 5.5 / 385 LFT: 27 / 13 / 80 / 0.4 / 0.2 / 6.4 / 3.5 UA: 2+ ketones, 2+ blood, 1+ protein, 0 WBC, 2-10 RBC, negative nitrite, leuk esterase, bacteria


  1. What is your differential diagnosis?

  2. How would you manage this patient?