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Image of the Week: A Woman with Chest Pain and Leg Swelling
A 34 yo woman with a past medical history of DM, HTN, and end-stage renal disease presented complaining of burning, non radiating chest pain and shortness of breath for the past day, and leg pain and swelling for the past week.  Her initial ECG is shown below.The most common cause of...
Which ED patients with acute respiratory failure might benefit from NIV trial?
 Which ED patients with acute respiratory failure could benefit from a NIV trial in an attempt to prevent need for intubation?Clinical Decision Rule: Summary by Dr. Amaan SiddiqiIntroductionNon-invasive ventilation (NIV) decreases the work of breathing – by recruiting previously...
Image of the week
CC:  Sudden onset severe pleuritic chest pain       There are two main types of PTX: traumatic and spontaneous.  A spontaneous pneumothorax can cause severe sudden onset pleuritic chest pain.  Risk factors include asthma, COPD, cystic fibrosis,...
Image of the week
70 yo F presents with RUQ pain and fever     Acute cholangitis is a bacterial infection characterized by fever, jaundice, abdominal pain with or without altered mental status and hypotension resulting from a biliary obstruction.   The majority of the time...
Image of the week
5 yo M presents with painful non-pruritic yellow crusting rash      Impetigo is a type of bacterial rash normally occuring on the face and extremities that progresses from papules to vesicles to pustules then crusts.  There are two main sub types of...
Which patients with trauma need foot, ankle and knee x-rays?
 Who needs foot, ankle and knee X-Rays?A summary of the Ottawa Rules for Imaging, By Jason Wilt, M.D.  Missing an ankle, mid-foot or knee fracture in a patient can cause significant morbidity, but for a long time, there were no hard and fast rules for when to get x-rays....
Image of the week
A 49-year-old man presented to the ED omplaining of 3 days of left-sided neck pain and swelling, and mild dysphagia. He did not experience any fevers, shortness of breath or cough. The patients past medical history was significant for end-stage renal disease. On exam he had a visible and palpable...
Emergency Medicine Update - July 2012
1)   Traumatic brain injury is catastrophic- just ask Marie Antoinette (true, that was a dislocation and not a true head injury). The question in this study was whether patients did worse if there was a 60 minute transit time, or they did worse when there was a need to be brought to a...
Image of the week
23 year old man visits the ED with 5 days of subjective fevers, general myalgia and headache. He tells you he just came back from Bangladesh where he spent 4 weeks in Dhaka and some outlying rural areas. His aunt had several days of fevers while he was there. You apply a blood pressure cuff to...
Which ED patients need a blood culture?
Which ED patients need a blood culture? Clinical Decision Rule Summary by Dr. Natasha DesaiIntroduction: Physicians has been shown to consistently overestimate the rate of bacteremia, often leading to over testing and contaminated blood cultures that result in unnecessary antibiotic use,...

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