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.
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