Case Scenario: A 38-year-old male with a history of hypertension and an unknown heart defect status post repair in infancy presents to the Emergency Department with acute onset chest pain, dyspnea, and diaphoresis.  He had a similar episode at another hospital 1 month prior that resolved after "some medication."  He denies drug use. An EKG is obtained in triage, and is shown below. The patient’s blood pressure is 120/70.  He is alert and oriented, and speaking in full sentences although dyspneic with respiratory rate in lower 20s and O2 saturation 98% on RA. Clinical Question: Which pharmacologic agent is most effective for termination of monomorphic ventricular tachycardia?

Click here to view Tintinalli's chapter on Cardiogenic Shock via Access Emergency Medicine!A 55-year-old man arrives via ambulance in respiratory distress. Paramedics attempted to start an intravenous line but the patient is altered and pulled it out. They were also unable to keep an NRB mask on him. His vital signs are: HR: 132, BP: 71/38, RR: 35, O₂Sat: 83% A quick bedside ultrasound reveals numerous B lines in both lung fields and markedly depressed left ventricular function. Based on your quick evaluation, you determine that the patient is suffering from cardiogenic shock. You are familiar with treatment of acute decompensated heart failure (ADHF) but are unclear on the management priorities and appropriate treatments in cardiogenic shock. [...]

"Once the classic symptoms appear and a definitive diagnosis is made, the very symptoms we look for have often become irreversible"

• Spinal epidural abscess is an extremely rare diagnosis but a potentially devastating one.
• It has proven to be a difficult ER diagnosis.
• Unfortunately, once the classic symptoms appear and a definitive diagnosis is made, the very symptoms we look for have often become irreversible.
• How can we change the way we evaluate for SEA in order to minimize diagnostic delay and thereby decrease morbidity/mortality?

"Beta blockers may improve hemodynamics, organ preservation, pressor requirements, and mortality"

Karalynn Otterness, MD presents a case of a patient presenting with chest pain who has a crucial finding on the initial ECG.

A review of the presentation, diagnosis, and management of this rare but deadly condition in the ED by Justin Arndt, MD.