You are working in a rural ER in a mountain resort town. A family of four is brought in because they have headache, nausea and malaise without syncope or chest pain. Following a thorough history and physical examination you quickly note the cause of the illness is carbon monoxide (CO) poisoning from a faulty heat generator. The closest HBO chamber is 300 miles away.

Another extremely busy day, but you feel a small sense of achievement as you prepare to discharge an 87-year old man with mild lower leg cellulitis. Your euphoria quickly evaporates as the nurse tells you that several family members are concerned that the patient has recently been demonstrating increasing signs of cognitive dysfunction.

A helpful application of the Canadian C-Spine Decision Rule, or an onerous malpractice risk?

You recently read a debate on the new American Heart Association guidelines for CPR on the blog WhiteCoat’s Call Room. Not long after, your local EMS director asks for your opinion about the evidence supporting compression-only CPR (COCPR) for witnessed cardiac arrest victims outside the hospital.

As you polish off the documentation on your last five patients, the nurse for the closed femur fracture patient asks if you are ready for the pending reduction. Orthopedic surgery is patiently waiting, and the nurse has the Propofol that you requested at the bedside.

Your local EMS will soon arrive with a spectator who had a witnessed cardiac arrest at a hockey game. Bystander CPR was immediately initiated but no onsite AED was available. On scene arrival, EMS found the patient to be in ventricular fibrillation (VF).

You are working in a busy ED when a one-year-old presents with first time wheezing, rhinorrhea and fever. The child is tachypneic at 44 breaths/minute and has mild indrawing accompanying the diffuse wheezes. Oxygen saturations are normal (98%) on room-air. The child is tolerating breast feeds well and appears well hydrated. You make the clinical diagnosis of bronchiolitis.

Chief complaint of “abscess.” Quick and dirty. Otherwise-healthy patient with a 4 cm abscess on the right thigh with no surrounding cellulitis. No IV drug use history. No significant co-morbidities, and no previous abscesses. Diagnosis: uncomplicated superficial cutaneous abscess (SCA). You know that antibiotics are probably not necessary after I & D. However, the patient complains of pain when you begin to pack it with iodoform gauze. He asks if packing is really necessary. Is it?

by Kevin Klauer, DO 
by Christopher Carpenter, MD, MSc

You are working a busy ED shift at your hospital, when a 68-year-old female presents with a two-day history of a swollen and sore left calf. The patient has no venous thromboembolic risk factors or trauma history. Your physical examination reveals a well-appearing, afebrile patient with a normal neurovascular exam and no associated cellulitis. Confronted with a differential diagnosis of DVT, phlegmasia cerulea dolens, ruptured Baker’s cyst or occult soft tissue injury, how do you proceed?

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