A 30-year-old male presents to the ER with right forearm redness, swelling and pain. On exam, you are unsure whether this infection represents cellulitis or abscess. You wonder if point-of-care ultrasound (POCUS) can be helpful. Superficial soft tissue infections are a common ED presentation. Cellulitis appears as an area of erythema, edema and tenderness. An abscess is suspected when a discrete fluctuant mass is palpated within the infected tissue. However, relying on these …
Substance use in the ED: Alcohol Use Disorders and the Emergency Department
Think back to your last three shifts. Did you see an alcohol related condition? You might even notice a pattern— the same patient, the “regular” who returns time and time again with the same presentation. You may even find yourself writing “discharge home when ambulatory” as you’ve “reached your wits end” and don’t know what to do anymore. The use of alcohol is common and the emergency department is often where we see …
What to do if your Patient is Poisoned by a Nerve Agent
While working in your emergency department, you receive news a number of patients have been found at a bus station unconscious. It is suspected that some sort of attack may have occurred. The first patient is brought to your ER, with obviously soiled clothing, vomiting and aggravated. As you make your way towards the bedside, the patient suddenly begins to seize. Overview: This past month, the assassination attempt of a Russian ex-spy and …
When and how to treat hyponatremia in the ED
Electrolyte imbalances like hyponatremia can be the cause of a variety of vague complaints. At the same time, patients may present with electrolyte abnormalities that are asymptomatic and are incidental findings on bloodwork. Here’s an approach to deciding when and how to treat hyponatremia in the emergency department. We also thank Drs. Joel Topf (@kidney_boy) and Dr. John Neary (@jddneary) for their valuable input on this article! The Case Marjorie, an 83-year-old female, …
Clinical Question: Can Ventolin improve wheeze in heart failure?
A 70-year-old male calls EMS with a 3-day history of shortness of breath. He sleeps in a chair because his breathlessness is made worse while lying on the flat of his back. He is working hard to breath and has difficulty speaking in full sentences. Physical examination reveals an elevated JVP, a third heart sound, and wheezes bilaterally with fine inspiratory crackles. He also has bilateral pitting edema to his hips. Vitals include a …
How useful is the physical examination in suspected cauda equina syndrome?
Background Cauda equina syndrome (CES) is a syndrome consisting of one or more of the following: (1) bladder and/or bowel dysfunction, (2) reduced sensation in the saddle area (i.e. the perineum and inner thighs), and (3) sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss or reflex change) [1]. The cauda equina is a latin name meaning horse’s tail and represents nerve roots L2 through L5. CES is caused by …