emDOCs Podcast – Episode 99: Multiple Sclerosis in the ED
Davis Sugar, Jess Pelletier, and Brit Long cover multiple sclerosis in the ED.
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#FOAMcc
EM@3AM: Malignant/Necrotizing Otitis Externa
A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks. He says the pain is worse at night and when he is chewing. Today, he noticed his right face looked swollen and he had an unequal smile. Triage vital signs include BP 130/75 mm Hg, HR 90 bpm, T 37C, RR 15 breaths per minute, SpO2 98% on room air. A point of care glucose is 148 mg/dL. On exam, the right side of the patient’s face is notably swollen. The right ear is anteriorly displaced by surrounding edema and is erythematous with malodorous discharge. There is facial asymmetry that involves the forehead. Otoscopic exam reveals granulation tissue.
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Journal Feed Weekly Wrap-Up
Clay covers three pediatric articles: the Phoenix Criteria for pediatric sepsis, extremes of weight and risk of intubation, and SBIs in premies.
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emDOCs Podcast – Episode 98: Post ROSC Mental Model
Zachary Aust and Brit Long cover a mental model for approaching the post ROSC patient.
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EM@3AM: Thoracic and Lumbar Spine Trauma
A 70-year-old female with a past medical history of osteoporosis, atrial fibrillation, and hypertension presents with acute thoraco-lumbar back pain after a ground-level fall. She is stable, but she does have pain at the T-12/L-1 region of her back. She has full motor strength and sensory function in the lower extremities. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence.
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Journal Feed Weekly Wrap-Up
Journal Feed covers ketamine versus etomidate, managing high-risk PE, and fludrocortisone plus hydrocortisone for septic shock.
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Journal Feed Weekly Wrap-Up
Journal Feed covers epinephrine versus airway first in OHCA, blunt head trauma in the elderly, and the ACEP guidelines on corneal abrasions.
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emDOCs Podcast – Episode 96: Lower GI Bleeding
Today we look at some finer points for the all too common lower GI bleeding.
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EM@3AM: Pneumocephalus
A 58-year-old female presents with severe headache and nausea. Her symptoms started shortly after leaving the office of her pain management doctor, where she had an epidural steroid injection to alleviate her chronic back pain approximately 30 minutes before she arrived in the ED. The patient denies any trauma to the head, fevers, nuchal rigidity, changes in vision, focal weakness, paresthesia, or anticoagulation use. On arrival, she is awake and alert and in obvious distress. Her vitals signs include temperature of 98.8F, HR of 64, BP 133/78, and O2 saturation of 98% on room air with a respiratory rate of 18. Her exam, including a complete neurological exam, is grossly benign. Given her acute complaint and recent history, labs and CT of the head are obtained. The clinician orders analgesics. The CT shows intracranial air.
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Pneumocystis jirovecii Pneumonia and HIV: A Practical Guide for ED Diagnosis and Management
How do you evaluate and manage the patient with Pneumocystis jirovecii pneumonia and HIV?