“I can’t believe I missed that airway!” she says. “I haven’t had that happen in years!” You reiterate how difficult the airway was, and you compliment her on changing her approach between attempts. “You know, Richard Branson once said, ‘Opportunities are like buses…there’s always another one coming’

You breathe a small sigh of relief when your senior resident begins presenting his next case to you. The patient is a 17-year-old G1P0 who found out she was pregnant via a home pregnancy test last month. She presents to the ED at 6 AM because she has been vomiting all night and can’t sleep.

You are about to start your shift after a somewhat lengthy department meeting where one of the main topics discussed was utilization review with a special emphasis on cutting down the number of unnecessary advanced imaging studies. The physician champion for cutting down on unnecessary imaging had a lot of valid points.

“We have 6 traumas coming our way, Doc. ETA is 15 minutes. We’ve mobilized backup. The ultrasound machines are in the rooms, and the residents are gowned and ready to roll. Is there anything else you need help preparing?” You give your favorite charge nurse a thankful smile and start preparing yourself for the organized chaos that is about to ensue.

Your next ED patient is a 47 year old male with a history of diabetes, hypertension, coronary arterial disease and CHF who presents with 2 weeks of gradually worsening leg swelling, abdominal swelling, and trouble sleeping due to orthopnea. He states that he has had the leg swelling and trouble breathing in the past from his CHF, but he has never had a “jelly belly” before. He denies any change in his medications or dietary indiscretion.