A 51 yo M presents to the ED with 2 self inflicted stab wounds to the neck 3 days ago. On exam, you notice two wounds to his anterior neck located near the laryngeal prominence. He is in no distress, however his voice is high pitched and he has extensive subcutaneous crepitus on examination of his face, chest and back. A CT neck and chest is obtained and shown below. What's the diagnosis? (scroll down for answer)
Dr. Billings, M.D., discusses 2 papers on the efficiacy & safety of Dobutamine versus Milrinone in the setting of cardiogenic shock.
A 4 year old boy, otherwise healthy, is rushed into the emergency room by his mom because she thinks he had a seizure. His mom states he was sitting on the ground playing a game on his iPad when he suddenly started having jerking movements of his entire body that eventually self resolved after around 2 minutes. He has never had a seizure before. He is up to date on vaccines and had an unremarkable birth history.
On exam, the child is not actively seizing at this time, he just seems slightly drowsy and confused. It is noted that he is febrile to 38.2 C, otherwise vitals are stable. The rest of the exam is nonfocal.
What should you be thinking about? What are your next steps?
There is a seemingly endless number of inborn errors of metabolism, and many of these children can present acutely to the emergency room. As emergency medicine physicians, we may not be experts in each of these diseases - but we still need to know how to resuscitate and care for these patients. Below is a general outline on how to approach most inborn errors of metabolism and general guidelines for resuscitation (besides the usual ABCs, IV, O2, monitor).
A young female presents complaining of severe abdominal spasms intermittently over days. She has a known neurologic condition which you have never heard of before. Read on to learn the basics of this rare disorder and how to deal with acute exacerbations in the ED!
