An 83-year-old male with a history of HFrEF (40%), CAD, hypertension, and hyperlipidemia presented to the ED with generalized weakness and fatigue. His vitals were remarkable for hypotension with a MAP of 58. On physical exam, the patient appeared non-toxic and was able to answer questions appropriately. He did not appear frankly fluid overloaded, other than mild, chronic peripheral edema. Additional laboratory studies and chest x-ray were performed. A fluid bolus was given to treat his hypotension, however there was minimal response. Given his heart failure, there was concern that aggressive fluid resuscitation would result in pulmonary edema. Additionally, inserting a central line and starting vasopressors is not without risk. Fortunately, this clinical team knows how to use ultrasound to do a proper volume assessment to manage this patient appropriately…
Read MoreThe goal of this post is to give you a systematic approach to a pediatric patient with lymphadenopathy. The differential is broad and the etiology ranges from benign to life threatening, and is most commonly benign. As such, to be a successful emergency room practitioner, it is vital to have a defined approach and know when to tune into high risk features…
Read More“The objective was to evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC)….
Read More“It would be unusual to go too many shifts as an emergency medicine provider without seeing the classic elderly female patient with hip pain after a fall. On exam, the patient would likely be uncomfortable with their hip appearing shortened and externally rotated on exam. Before you even view the X-ray, you know they likely fractured their hip. You ascertain whether it was a mechanical fall, if there were other injuries, if the injury is open or closed and if the patient is neurovascularly intact. You proceed to order your imaging and consider your plan for pain control. Sound familiar…”
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