An 82 yo male presents to the ED complaining of several months of progressive hearing loss in the right ear. For the past 3 days, he can hear a male voice singing opera in the right ear only, 24/7. Read on for a brief discussion of this fascinating phenomenon and how we cured him in 5 minutes!
Check out this lateral film of the wrist. See the fracture? Look again! Surprise...there is no fracture, but this patient has sustained a serious wrist injury with the potential for long term disability. This week we highlight some of the most common missed orthopedic injuries in the ED and suggest a few strategies to minimize the errors.
A 25 yo male with a hx of ESRD due to membranoproliferative glomerulonephritis (MPGN) presents to the ED with complaints of swelling to his LUE, face, and neck progressive over 5 days. He was seen at another ED 2 days prior and had an ultrasound of his LUE fistula as well as a duplex of his LUE which were unremarkable. A CT scan of the chest was ordered, revealing bilateral occluded brachiocephalic veins, which were treated in the interventional radiology suite with balloon venoplasty with resultant resolution of edema.
Lemierre Syndrome is thrombophlebitis with infectious involvement of the carotid sheath vessels and bacteremia. It is an extremely rare condition also known as jugular vein suppurative thrombophlebitis, postanginal sepsis and necrobacillosis, which usually affects previously healthy / young adults (approx. 20 y/o).
An elderly female patient presents with abdominal pain and distention with no bowel movement in 1 week. Labwork shows a Cr of 8 from baseline of 1 with a normal lactate. Click for further information about her diagnosis.
A 50 year old male with a recent lung mass resection presents with chills and diffuse burning rash. Patient was well appearing and afebrile. There were no mucosal lesions. Initial lab testing was significant for a leukocytosis of 19 with 89% neutrophils. Patient was started on steroids and observed in the hospital.
For decades, Emergency Medicine Providers have struggled to come to a consensus on the management of patients with chest pain with non-ischemic ECGs and negative biomarker testing. Both cardiology and emergency medicine guidelines failed to provide a clear recommendation on which patients should be discharged from the ED. The American College of Emergency Physicians has taken a bold step with their latest guidelines for the management of low risk chest pain patients which will dramatically change standard practice in the care of possible ACS patients.
With the rise in popularity of the NOAC class of anticoagulants, more and more patients with a new diagnosis of pulmonary embolism are being discharged from the emergency department. Multiple risk classifications tools have been developed to help identify patients at low risk of short term mortality. Read on to see if this new study determined which tool is the winner!
Treatment of diabetic ketoacidosis in the emergency department includes aggressive volume repletion and administration of insulin, however it is also extremely important to address electrolyte abnormalities…
After reading the Back to the Basics post below, you decide you need a urine sample for your febrile infant. Can you use a urine collection bag? It just seems easier for everyone involved, right? Click to see why that is the wrong answer.