Core Emergency Medicine

This post explores femoral neck fractures - classification, diagnostics and management.

This post dives into the management of supracondylar fractures and talks about some of the complications to look out for.

Core Procedures See More →

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

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

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Core Blog See More →

Nov172017

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,
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Oct062017

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.
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Sep122017

The MDCalc Fellows program is a 2-year longitudinal engagement for residents and medical students passionate about EBM and knowledge translation. 
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Core Journal Club See More →

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Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy is Identified on Ultrasonography? A Randomized Controlled Trial Ann Emerg Med, 2017

First trimester vaginal bleeding is a common complaint seen in the Emergency Department (ED).  Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies. 
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The benefit of paracentesis on hospitalized adults with cirrhosis and ascites J Gastroenterol Hepatol, 2016

Ascites is the most common complication of liver cirrhosis, and infection of that abdominal fluid, spontaneous bacterial perotinitis (SBP) is both common (reported in 10-30% of hospitalized patient) and deadly,
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Core Case of the Month More Cases →

CC

Shortness of breath and abdominal pain

HPI

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
NCAT EOMI PERRL, dry MMs
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
No CVAT
Ext warm, no edema
Skin dry
Awake, alert, moving all extremities spontaneously

Labs

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

Questions

  1. What is your differential diagnosis?

  2. How would you manage this patient?