Continuing with our EM Mindset series, here is piece by Dr. Joshi as she talks about "An Emergency Medicine State of Mind." Enjoy!
An update on the deadly condition of cardiac tamponade, with pearls in management and the necessary procedures to save a patient's life.
A 25 year-old female is suddenly rolled back in a wheelchair into your resuscitation area. As you walk into the room, you see a pale, ashen lady with a diffuse red rash holding an emesis basin between her legs filled with a mixture of sputum and blood. You glance up to the monitor as your nurse places a second peripheral IV, and you see an oxygen saturation of 88%, RR of 28, BP of 105/92, HR of 122, and temperature of 99.1. She continues to cough and is barely able to speak due to increased work of breathing. You immediately call for intubation equipment and medications. The intubation goes well with ketamine and rocuronium, despite blood pooling in the oropharynx. The post intubation chest xray demonstrates diffuse infiltrates.
It’s 3pm on a Monday after a holiday. The department is bustling, and you feel like there are patients crammed into every conceivable space. Alarms are going off on patient monitors. You’re in the midst of discussing a case with a resident when a nurse puts an ECG in front of you to review and sign. Just as you finish reviewing the ECG, you turn back to your resident, only to get a phone call from the radiologist notifying you of an abnormal finding on another patient’s CT scan. After looking through the scan, you help guide your resident through an appropriate plan and disposition of the patient they saw, and decide it’s time to round on a few patients you need to see. As you rise from your chair, your EMS phone goes off, and you get word of a cardiac arrest that will arrive in 5 minutes. It’s just then that you realize you have to pee so bad it hurts. Sounds like a typical emergency department shift for many of us, doesn’t it?
An emergent condition we all learned about for pediatric patients. Except it happens in adults too.
Continuing with our EM Mindset series, here is another piece by Dr.Broders to kick off your week as he reflects on his 40 year experience. Enjoy!
A review and update on ARVD/C: What do ER physicians need to look for in the history, exam, and ECG?
The crashing neonate: What could possibly go wrong? An updated review with pearls and pitfalls in the presentation, diagnosis, and management of inborn errors of metabolism
