Core Emergency Medicine

Anti-D Immunoglobulin is commonly given in 1st trimester pregnancy with bleeding but is it effective in preventing isoimmunization?

This post discusses the diagnosis, classification and management of hip dislocations in the ED.

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This week we delve into the argument for cardioversion in recent-onset AF as well as the logistics of getting it done.

This week we discuss the rare but life-threatening methemoglobinemia with a focus on recognition and use of the antidote.

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

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This video discusses how a magnet helps you in the management of pacemaker mediated tachycardia + inappropriate shocks

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May222017

SIMWars is a competitive learning environment held every year at the ACEP Scientific Assembly in October and the SAEM Annual Meeting every May. It pits residency teams from across the country against each other as they manage complex patients. This year, the NYU/Bellevue EM Resident team of Allan Guiney (PGY3), Joe Levin (PGY2), Magdalena Robak (PGY1) and Kristen Ng (PGY1) took home the championship!
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May122017

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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May052017

Over the last year, the SMACC group has released some absolutely amazing talks from SMACCDub in Dublin in June of 2016. In the true spirit of FOAM, all of the content is free for use and reuse. Among the many amazing talks was this one from the FeminEM crew. For all the SMACC talks,
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Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients Ann Emerg Med, 2017

This post is cross-posted on REBEL EM here.

Etomidate and ketamine are both routinely used as induction agents during rapid sequence intubation (RSI) in trauma patients.
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Safety of Computer Interpretation of Normal Triage Electrocardiograms Acad Emerg Med, 2017

The Emergency Department, by its nature, is interruption driven given it is “uncontrolled and unpredictable and punctuated by intermittent time-critical activities (Chisholm 2000).
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Core Case of the Month More Cases →

Case:

CC

Cyanosis

HPI

83yF PMH HTN, HLD p/w fatigue and cyanosis. Reports that all day she has been feeling fatigued and was noted to have a blue color so her son called 911. On arrival she is cyanotic and hypoxic to 80-85% on NRB. Denies fevers, chills, chest pain, shortness of breath, cough, abdominal pain, nausea, vomiting, diarrhea, dysuria, hematuria. Patient denies any toxic ingestions or recent medication changes.

PMH / PSH

PMH: HTN, HLD
PSH: None
Medications: Celebrex, Meloxicam, Cyclosporine 0.05% 1 drop BID, Tolterodine, Pitvastatin, MVI, Omega 3

Physical Exam

VS: 36.6, 90, 122/59, 25 80% on NRB
Gen: NAD
HEENT: NCAT, +periorbital and perioral cyanosis, OP clear, neck supple
Cardiovascular: RRR, no m/r/g
Pulmonary/Chest: Effort normal. No respiratory distress. No w/r/r
Abdominal: Soft, nt/nd, no r/g, normal BS
Extremities: Cyanosis to b/l hands and feet, warm to touch, no edema
Neurological: AAOx3, CN II-XII intact, strength and sensation intact

Labs

ABG: pH 7.484, PC02 32.8, P02 307, HC03 24.3 Lactate 1.8
Troponin: 0.02
WBC: 8.2, Neut 89%, Hgb 10.5, MCV 93.7, Hct 31.1, Plt 218
Na 141, K 4.7, Cl 103, BUN 35, Cr 1.0, Glucose 120, Ca 8.9, AG 12,  
Bili Tot 0.4, Bili conj 0, Alk P 65, AST 18, ALT 22, Alb 3.4, Protein 6.1

CXR: No evidence for acute pulmonary pathology

Questions

  1. What laboratory test will confirm your diagnosis?

  2. What is the treatment?