Brit Long

“Remember that patient you saw?” The tricky diagnosis of flu-like symptoms associated with a rash and a tick bite. Pearls and pitfalls in the management of RMSF.

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:

An update on pacemakers and AICDs: What do you need to worry about? What are vital components of the history and EKG? What are the management strategies for these patients?

The airways that even the experts at airway cringe at a little. The ones you pee your pants over. The ones you hear in myths and legends. These airways, my friends, are where heroes are made.

An update on the emotionally charged and difficult-to-diagnose subject of intimate partner violence. What screening tools are available, and how can ED physicians combat this epidemic?

An update on the deadly condition of cardiac tamponade, with pearls in management and the necessary procedures to save a patient’s life.