Core Emergency Medicine

This post reviews the emergency management of patients presenting with priapism.

This post investigates a cognitive process for the patient with refractory hypotension.

Core Podcast See More →

This podcast takes a deep dive into the presentation, diagnosis and management of preeclampsia and eclampsia.

Core Procedures See More →

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

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A brief video on how to perform and incision and drainage of a cutaneous abscess.

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Core Blog See More →

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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Sep052017

If you’re looking for a fellowship in Ultrasound, Pediatric EM, Toxicology, Healthcare Leadership or Quality and Safety, check out the opportunities available at our program.

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Aug182017

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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Core Journal Club See More →

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Amiodarone and cardiac arrest: Systematic review and meta-analysis Int J Cardiol, 2016

In 2016 the annual incidence of out-of-hospital cardiac arrest (OHCA) in the United States was roughly 360,000 and 209,000 for in-hospital cardiac arrest (IHCA) (Mozaffarian 2016).
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A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses NEJM, 2017

Skin and soft tissue infections (SSTI), specifically skin abscesses, are an increasingly common cause for emergency department (ED) visits. Many of these are uncomplicated and are treated in the ED with incision and drainage (I&D) and then discharged.
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Core Case of the Month More Cases →

CC

Fever and cough

HPI

59yF HIV on ART last CD4 716, undetectable VL, HTN, CKD p/w non-productive cough and fever x10d. 5d PTA she presented to the ED for dry cough, had CXR WNL, lab values WNL except Cr 3.2 and was discharged with f/u. Symptoms have continued since and she returns now because she has dyspnea at rest x 1d. Also c/o fatigue, chills and loose stools. She denies chest pain, headache, change in vision, rash, sick contacts or recent travel.

PMH / PSH

PMH: CKD, HTN, HIV
PSH: none
Meds: HAART, losartan, spirinolactone, chlorthalidone, crestor, clonidine, amlodipine
NKDA

Physical Exam

BP 120/70 HR 104 Resp 20s Sat 92% on 2LNC Temp 102.9F
General: tachypneic but in NAD
HEENT: NCAT, EOMI, PERRL, dry mm
CV: tachy, no m/r/g
Pulm: CTA throughout, but tachypneic on 2L O2
Abdomen: protuberant, soft, nondistended, no ttp, rebound or guarding
Neuro: Awake, alert, oriented, normal strength, sensation, coordination
Ext: normal active ROM, no deformities or edema
Skin: no diaphoresis, rashes, or lesions. Warm and dry.

Questions

  1. What is your differential for this patient? What’s at the top of your list?

  2. What are the next steps in management of this patient and your anticipated disposition?

  3. What one lab test would you send, if you had to clinch the diagnosis?