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practice updates

Neonatal Resuscitation

Neonatal Resuscitation Highlights Author: Geoff Jara-Almonte, MD (PEM Fellow, NY Methodist Hospital) // Edited by: Jennifer Robertson, MD and Alex Koyfman, MD (@EMHighAK) You are midway through an overnight shift in a suburban emergency department (ED) when a young woman is dropped off by her partner in labor. The triage nurse brings her to an […]

clinical cases

Mucormycosis: What are we missing?

A 42 year-old female with poorly controlled type II diabetes presents with several days of fatigue, headache, fever to 102F, and sinus pressure. She does not regularly check her blood glucose, with her last check at 320. Initial vital signs show a blood pressure of 155/92, heart rate of 92, oxygen saturation of 97% on room air, temperature of 102.2, and respiratory rate of 24. Initial D-stick is 330. You order some labs, which reveal an anion gap of 22, bicarbonate of 11, with glucose of 322 and potassium of 4.2. Your ECG obtained is normal. You begin your standard treatment for diabetic ketoacidosis. As you begin to go through your algorithm for management/treatment of DKA, you question why the patient is in DKA. You remember that she has had several days of headache, fever, and sinus pressure. You go back into the room after the 1L bolus to complete your exam, and what you see on your exam surprises you:

practice updates

Ultrasound for Achilles Tendon Rupture

Combined with physical exam (+ Thompson's test), here's a a quick, cheap, readily available way to assess dynamic motion and contralateral evaluation for possible Achilles tendon rupture. The answer may not be definitive without further MRI, but perhaps get Ortho's attention without a formal radiograph.