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.

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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.

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

Background

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