Welcome to Part II of our evaluation of acute heart failure myths versus facts. This post will look at ED management of heart failure exacerbation.

We see heart failure on a daily basis. Where could we go wrong? This post will examine some myths and misconceptions in heart failure evaluation.

A 23-year-old female presents with left foot pain after rolling her ankle in volleyball. She has some minor ankle pain, but her lateral foot is painful to touch or with weightbearing. On exam, the base of her 5th metatarsal is tender to palpation, with swelling and ecchymosis. What are your next steps, and what is the likely diagnosis?

The patient with flu-like illness and diffuse erythroderma who appears sick... What should you consider? Could it be toxic shock syndrome? This post provides keys in the evaluation and management of toxic shock syndrome, as well as a downloadable handout.

A 61-year-old male presents with lower abdominal pain on the right side. He says “I’ve had this bulge in my groin on the right for two days”. You find a small bulge in the right groin, but with no redness or discoloration of the skin. Palpation reveals mild tenderness over the site. What’s the next step in your evaluation and treatment?

A 57-year-old male presents with hematemesis. He has a history of cirrhosis from alcohol abuse. He appears toxic and is rushed to the resuscitation bay.  Initial VS include T 37.2C, HR 122, BP 88/41, RR 24, SpO2 90% RA. What are your next steps, and what is the likely diagnosis?

A 77-year-old female presents with left proximal femur and hip pain after falling from a standing position. She tripped over a rug and landed on her left side. She denies LOC or other symptoms. Her left leg is shortened and externally rotated. Her pulses in the leg are normal, and she is able to move her foot and toes. What are your next steps, and what is the likely diagnosis?

A 37-year-old male presents with altered mental status. He has a history of recurrent alcohol intoxication, and his wife found him on the couch after he was working in the garage. She is concerned because he seems to be much more intoxicated than is usual. She also found spilled containers of antifreeze in the garage. What could be going on with this patient? Is he just intoxicated?