A 37 yo female presents with chief complaint of "electric shock" sensations down her arms and intermittent nausea/vomiting over the past week. Her vital signs are unremarkable. Little do you know that this young, well appearing patient has an acute medical emergency which will result in cardiac arrest in a few hours....

Can patients presenting with syncope safely be discharged from the Emergency Department? 

45-year-old female presents to the Emergency Department with worsening shortness of breath over the past two days.

45 year old female presents with 3 days of cough, congestion and chest discomfort.

History

• 49 yo F  pHx asthma presents  ED with worsening DOE for the last month acutely worsening today 
• No prior hospitalizations or intubations for asthma exacerbation 

ROS

• Positive for dyspnea, palpitation
• Positive for abdominal distention, which she attributes to constipation

PMHx

• Moderate intermittent asthma on albuterol PRN 

Physical Exam

A 60 year old male with a history of CHF s/p LVAD presents to the ED with fatigue. You are called to triage because although he is awake and speaking, the RN can’t find a pulse or obtain a blood pressure. You auscultate a hum over the device. What do you do?

LVADs (Left Ventricular Assist Device) are 

Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818