recent articles


EM@3AM: Diabetic Ketoacidosis

A 37-year-old female presents with dysuria, polyuria, polydipsia, and lightheadedness. She has a history of insulin-dependent diabetes but ran out of her glucose strips at home. She has had significant nausea and suprapubic pain. She is tachycardic and tachypneic. Exam reveals dry oral mucosa and suprapubic tenderness. POC glucose is 422 mg/dL. What is the diagnosis, and what are your next steps?


EM@3AM: Esophageal Foreign Bodies

A 52-year-old male presents with inability to swallow. He was eating steak one hour ago and swallowed a large piece without chewing. He thinks it is stuck around his upper sternal area. Physical exam reveals a patient who appears uncomfortable, sitting upright, constantly spitting into a bag. You do not see anything in his mouth. What is the next step in your evaluation and treatment?



A 28-year-old female presents with right lower leg swelling and redness. She just returned from an overseas flight. She denies chest pain or shortness of breath. VS are normal, and her right lower leg is swollen, with diameter > 3 cm compared to her left. What’s the next step in your evaluation and treatment?


EM@3AM: Toxic Megacolon

A 28-year-old male presents with abdominal pain, diarrhea, distension, and fever. He has a history of ulcerative colitis. Vital signs include BP 97/58, HR 121, T 100.9 Oral, RR 24, SpO2 98% on RA. Exam reveals a patient who appears systemically ill, and his abdomen is diffusely tender. His bowel sounds are decreased, but he has no peritoneal findings. KUB shows markedly dilated loops of bowel. What's the next step in your evaluation and treatment?


EM@3AM: Small Bowel Obstruction

A 63-year-old female presents with abdominal pain, decreased bowel movements, nausea, three episodes of vomiting, and abdominal distension. She has a history multiple abdominal surgeries. Exam shows abdominal distension and generalized tenderness, but no peritoneal signs. What are your next steps?


EM@3AM: Acute COPD Exacerbation

A 58-year-old male presents with severe shortness of breath, productive cough, and decreased ability to ambulate at home. He has COPD and is on oxygen at home. Several days ago he noted worsening congestion, myalgias, and cough. He is now severely short of breath and unable to complete his activities of daily living. He is hypoxemic and tachypneic. You hear decreased air movement bilaterally and distal wheezes. What's the next step in your evaluation and treatment?

practice updates

2018 AHA/ASA Ischemic Stroke Updates

With all the new stroke literature, how can you keep track of everything? Fortunately, the AHA/ASA recently published the 2018 ischemic strokes guidelines. This post provides emergency medicine-focused highlights of the updated guidelines.