Core Emergency Medicine

This post discusses a common, painful entity; herpes zoster.

This post dives into acute rhinosinusitis with a focus on clinical identification and determining the benefits of antibiotic therapy.

Core Podcast See More →

This week we discuss some quick pearls from our conference covering an array of renal and GU pathologies.

Should we intubate patients in cardiac arrest? We discuss this topic and some basics of running a good arrest.

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 →

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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Aug152017

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

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Jun302017

“Just cut. He’s dead”, my senior resident calmly whispered behind me. I had walked through the crash chest tube hundreds of times in my head. I knew the steps like the back of my hand – fourth or fifth intercostal space, mid-to-anterior axillary line, cut above the rib, bluntly dissect with the Kellys, pop through the pleura,
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Core Journal Club See More →

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Randomized Trial of Icatibant for Angiotensin-Converting Enzyme Inhibitor-Induced Upper Airway Angioedema J Allergy Clin Immunol Pract, 2017

Angiotensin Converting Enzyme Inhibitors (ACE-I) are prescribed to millions of patients in the US. Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department.
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Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests- The PRICE Randomized Clinical Trial JAMA Intern Med, 2017

In the US, vast differences in pricing exist for the same medical services across the country, with no correlation shown between price and quality (Sinaiko 2017).
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Core Case of the Month More Cases →

CC

Abdominal pain

HPI

27yF with h/o anxiety p/w abdominal pain x1d. Pain started yesterday evening, intermittent, a/w nausea and diaphoresis. Began as generalized pain but when supine, radiates to chest a/w mild SOB, otherwise localizes to the right abdomen with radiation to the pelvis.

Denies fever, chills, diarrhea, anorexia, blood in stool, recent travel, sick contacts. Sexually active with one male partner, denies STIs, uses OCPs, LMP 3 weeks ago. Denies vaginal bleeding or discharge.

The remainder of the patient’s labs other than those given are pending. On assisting the patient to the OBGYN room, she becomes markedly diaphoretic, lightheaded, tachycardic to 125, and hypotensive to SBP in the 60s. Repeat EKG shows sinus tach, portable CXR is unremarkable, and a RUSH bedside ultrasound exam notable for free fluid in the pelvis.

PMH / PSH

PMH: anxiety, HPV
PSH: none
Social: denies tobacco, drug use. Rare social etoh
Meds: OCPS
Allergies: NKDA

Physical Exam

BP 96/52 HR 99 Resp 18 Sat 100% Temp 96.0
General: well-dressed, appears stated age, lying semi-recumbent in stretcher, no acute distress
HEENT: NCAT, EOMI, PERRL
CV: RRR, no m/r/g
Pulm: CTA throughout, breathing comfortably on room air, tachypneic when supine
Abdomen: soft, nondistended, mild TTP in RLQ, no rebound or guarding
Neuro: Awake, alert, orient, normal strength, sensation, coordination
Ext: normal active ROM, no deformities or edema
Skin: no diaphoresis, rashes, or lesions. Warm and dry.

Questions

  1. What next steps would take in the management of this patient?

  2. What is your differential for this patient?