Today the emDOCs cast covers CAR T-cell therapy and Cytokine Release Syndrome.

A 72-year-old male presents with left-sided flank pain for the last two weeks that has worsened over the past several hours. He also feels lightheaded when standing today. He is tachycardic to 124 beats per minute and hypotensive to 117/84 mm Hg relative to his chart baseline which has an average systolic in the 160s mmHg. You cannot reproduce his pain on your abdominal exam, but you feel a thrill with deep central abdominal palpation. What is the likely diagnosis, and what are your initial steps in evaluation and management?

EM Educator returns with meningitis.

Journal Feed looks at hyperacute T waves, early PCC in trauma, and ST elevation in aVR.

52 in 52 covers the PREVENT trial for this week's article. Does low (6 mL/kg) tidal volume reduce ventilator free days in ventilated patients without ARDS compared to intermediate tidal volume (10 mL/kg)?

Dr. Pilcher covers a case of testicular torsion and the question of "gross negligence" in this month's medical malpractice insights.

Today the emDOCs cast looks at giant cell arteritis (GCA), also known as temporal arteritis.

A 59-year-old male presents to the ED with abdominal pain, hematuria, and rectal bleeding for the 5 days. His symptoms have been associated with unintentional weight loss, intermittent fevers, skin rash, and fatigue over the past 3 months. He has a past history of hepatitis B, hypertension, diabetes, and hyperlipidemia. Vital signs include blood pressure 162/103 mm Hg (last measured 118/82 5 months ago, per records), HR 101, RR 18, SpO2 98% on room air. Exam is notable for generalized abdominal tenderness, guaiac positive stool, and generalized purpuric rash over bilateral lower extremities. Labs demonstrate Cr 2.9 (baseline 1.1) and elevated ESR and CRP. What is the most likely diagnosis, and what are the next steps in management?