The EM Educator series looks at empyema.

This post covers the presentation, evaluation, and management of empyema.

The emDOCs Podcast covers severe asthma and asthma mimics.

What should you consider in determining disposition for the patient with asthma or COPD exacerbation?

What can you use to determine whether the patient with community acquired pneumonia can be discharged from the ED?

A 66-year-old male presents via EMS in respiratory distress. For the past several days he has had worsening productive cough, chest pain, dyspnea, and fever. He appears fatigued, is sitting up in bed, and has increased work of breathing. On exam there is no JVD, 1+ edema, and crackles bilaterally. Vital signs include T 102.1 F, HR 110, RR 28, BP 94/62. Chest Xray shows bilateral infiltrates. What is the likely diagnosis?

A 30-year-old male presents after a motor vehicle accident with chest pain and shortness of breath. He is alert, speaking in 1-2 word responses, and appears in moderate respiratory distress. He has normal left sided breath sounds, but none on the right. No lung sliding is seen with ultrasound examination of the right thorax. His trachea is deviated left, and increased JVD is noted. What is this patient’s presentation consistent with? What is your next step in management?

How do you evaluate for suspected pleural effusion, and what tools do you have for diagnosis and therapy?