A 38-year-old male presents from triage in a hospital wheelchair with his head slumped to one side. You immediately move him into bed and assess his ABCs. He wakes briefly, but he seems to be hallucinating. Vital signs: BP 154/110, HR 110, T 102.1, RR 20, SpO2 100% on room air. Physical exam reveals mydriasis and diaphoresis. He has track marks on his arms and you find packets of what appears to be mixed prescription drugs, heroin, and methamphetamine in his pocket. What’s this presentation most consistent with? What’s your next step in evaluation and treatment?

Did you know that a single 5 cc saline push can likely confirm correct line placement?

Cleavon MD is back with bradycardia!

The EM Thinker series returns with pearls for your next shift.

How do you evaluate and manage the patient with complication from a nephrostomy tube?

Clay and Journal Feed are full of greatness this week with caudal equina, ultrasound in unstable PE, cerebellar bleeds, and adrenal crisis. Read on for more!

Check out this high-yield post on vertical shear fractures from CORE EM!

Nonaccidental trauma isn't always easy to pick up, but we need to know when to suspect it and how to manage it. This EM Educator brings you cases, considerations, and resources for your next shift.