A 59 year-old male presented to the emergency department with a chief complaint of difficulty concentrating and loss of vision. He had presented to the same facility the day prior for chest pain, chills, and a cough. During his prior visit, the patient underwent a chest x-ray which demonstrated a consolidation suggestive of a lobar pneumonia and was subsequently discharged home with a prescription for Azithromycin as well as instructions to follow-up with his primary care doctor. However, he was unable to fill his prescription. Upon attempting to drive home, the patient was pulled over by law enforcement because he was acting “delirious.” Despite the traffic incident, he was allowed to return home. The patient reported that once he arrived at home he began bumping into furniture, experiencing difficulty with concentration, and suffered vision loss. In addition, he continued to experience chills, chest pain, and shortness of breath.
Author: Stephen Alerhand MD (EM Resident Physician, Icahn School of Medicine at Mount Sinai) (@SAlerhand) // Edited by: Alex Koyfman MD (@EMHighAK) Situation A 6 year-old right-handed female patient walks into your ED with her parents complaining of pain to her left hand. According to her parents, the patient began complaining of pain sometime in […]
As trainees I think it is beaten into our heads that all males over the age of 50 with new onset hematuria and flank pain should also be screened for AAA. One thing that is not so much beaten into our heads is how we still have to take hematuria and or hematochezia seriously in these same patients even after they receive endovascular repair. There are many complications that can occur from having an aortic graft placed, but for the purpose of this article let’s focus on Aortoenteric fistula and Endoleaks.
BNP (Brain Natriuretic Peptide) is a commonly used biomarker for detecting heart failure in the emergency department. It’s levels can be affected by various extraneous factors such as obesity and renal failure. This article reviews the potential uses of BNP, including its pros and cons, in the emergency department.
The pregnant patient with nausea and vomiting is something most providers want to avoid. A wide range of conditions can cause these symptoms in the pregnant patient, and these conditions can range from the benign morning sickness to life-threatening preeclampsia and acute fatty liver of pregnancy. What can you do to manage these patients while diagnosing severe disease?
Airway management is a vital component to caring for critically-ill patients in the emergency department. The peri-intubation time can be chaotic. Planning for the difficult airway and preparing for all possible scenarios is best done before the arrival of a crashing patient. The following post explores some common failures in airway management and how to avoid making fatal mistakes in a critical situation.
The Institute of Medicine’s 1999 report “To Err is Human: Building a Safer Health System” drew attention to medical errors and the need for improving quality and safety in medicine. Since then, a body of literature has emerged suggesting that transparency around adverse events and medical errors benefits both providers and patients. However, the actual rate of disclosing medical errors has lagged behind popular support for the concept.
Young patient or old…every emergency physician has come across these questions: Should I send a troponin for supraventricular tachycardia, or not? If I do, what does it mean if it comes back elevated? What comes next?