Rachel Bridwell

A 24-year-old female presented to the ED for pelvic pain that started 8 hours ago. The patient reports sudden onset pain that is getting progressively worse, along with vaginal bleeding. The patient has not had unprotected sex and no history of sexually transmitted infections. She appears visibly uncomfortable, is tachycardic, has dry mucous membranes, and is tender in the suprapubic area. Pelvic exam reveals scant blood per os, IUD strings seen, and she has pain with bimanual uterine palpation. What’s the next step in your evaluation and treatment?

A 25-year-old male is brought to the ED by EMS with pain in the right scrotum after a motorcycle crash. The patient was wearing a helmet, could ambulate at the scene, and states his main concern is his right scrotal pain. Review of systems is unremarkable. He has ecchymosis of right scrotum with exquisite tenderness and perineal bruising. What’s the next step in your evaluation and treatment?

A 32-year-old female with a previous medical history of acne on isotretinoin presents to the ED for 2 months of headaches that awake her from sleep, more prominent in the morning. She also endorses nausea and vision changes. She notes that her vision is blurry especially in her periphery.  The patient denies the possibility of being pregnant.  She denies fevers, neck stiffness, facial weakness, dysarthria, and personal history of cancer or venous thromboembolic events. Neurologic exam is normal. What’s the next step in your evaluation and treatment?

A 67-year-old female with a history of ALL comes into the ED for weakness, stating her oncologist sent her for her semi-regular transfusion. From review of the EMR, her hemoglobin in 5.9 mg/dL and her platelet count was 1,000 cells/uL. A transfusion of platelets was initiated, though within approximately 1 hour of starting the transfusion, the patient became acutely short of breath and stated she was having severe difficulty breathing. She is in distress with rhonchi bilaterally. What’s the next step in your evaluation and treatment?

Managing pulmonary hypertension can be tricky. This post from Rachel Bridwell provides you with what you need to succeed.

A 67-year-old female with a history of CHF and CKD was brought in by ambulance from her nursing home for a gastrointestinal bleed. The patient’s total fluid balance from her nursing home was 2.5L over the past 24 hours. Her point of care hemoglobin is 4 g/dL and a transfusion of 2U pRBC and 1 FFP was initiated, though within approximately 1 hour of starting the transfusion, the patient became acutely short of breath and stated she was having severe difficulty breathing. What’s the next step in your evaluation and treatment?

What’s Pediatric Junctional Ectopic Tachycardia, or JET, and how is it managed?

A 22-year old male presents to the ED after landing on his right thumb while playing football with some friends. The pain and swelling became progressively worse as he notes pain with any movement of his thumb. He is right hand dominant. On exam, the right MCP joint is edematous with point tenderness and ecchymosis, though the skin is closed. What’s the next step in your evaluation and treatment?