A previously well 41-year-old woman on OCP presents to the emergency department with acute-onset tachycardia, dyspnea, and leg swelling. While awaiting imaging, she rapidly deteriorates and BP drops to 86/60 (triage BP 134/78). CT shows bilateral pulmonary emboli. Risk Stratification Pulmonary embolism (PE) is a cardiovascular emergency which can result in significant morbidity and mortality for patients.1 It is classified as high risk (formerly “massive”), intermediate (formerly “submassive”), or low risk. High-risk PE …
Dress for Success: A Guide to Dressing Choices for Common Wounds in the Emergency Department
During your Emergency Medicine (EM) rotation, you’ve encountered numerous lacerations and have honed your suturing skills. Following the primary closure of your most recent laceration, your supervising physician has requested that you apply an appropriate dressing and provide wound care instructions, as the nursing staff are preoccupied with attending to other patients. You look at the Wound Product Information Sheet and are surprised by the variety of dressings available in the Emergency Department …
Initiation of Congestive Heart Failure Action Plan in the Emergency Department
A 72-year-old English-speaking male with a history of congestive heart failure (CHF) withreduced ejection fraction (EF) presented to the emergency department (ED) with acutedecompensated CHF. He had a two-year history of progressive dyspnea and exercise intolerance.Other comorbidities included coronary artery disease, hypertension, dyslipidemia, cardioembolicstroke, and gastroesophageal reflux disease. His medications included furosemide, apixaban,atorvastatin, carvedilol, and fosinopril. His furosemide was reduced from 40 mg to 20 mg daily by hisfamily physician five months prior …
An Approach to Adult Burns in the Emergency Department
Case: You are working as a 3rd year clerk in the ED and your staff has asked you to see Kathy, a 24 year old female caught in a house fire presenting with burns in multiple areas and difficulties breathing. Burn injuries result in the partial or complete destruction of the skin and can affect any of its three layers: the epidermis, dermis, or subcutaneous tissue.1 In this article, we will explore a …
Clinical Question: How do I measure frailty in the Emergency Department?
Mrs. Vivianne Dubois is an 84-year-old female presenting to your Emergency Department with her daughter. She tells you that she is here because she has been feeling weak and has had a fall. You speak to her daughter and find out that in the past year since her husband’s death, Vivienne has been struggling to take care of herself, requiring assistance with bathing and cooking. Recently, she has had several falls, and her …
Opioid Use Disorder Treatment: Opioid Agonist Therapy Induction
Venus is a 29-year-old female who presents to the ED with tremor and diaphoresis. You learn that she has presented to the ED with similar symptoms before, and has a 5yr history OUD, using about 5 points (0.5 g) a day. She has no other medical conditions and blood work is within normal limits. Venus is tachycardic at 105 bpm, with dilated pupils, piloerection, slight tremors, and flushed face. You remember a previous …