Island Med: Challenges of Remote Healthcare

A 60-year-old man with a history of hypertension and smoking presents to the medical center with chest pain. Over the weekend, he developed chest pain while cleaning out his gutters that resolved with rest. This morning, he was working at his computer when he developed chest pain radiating to his left arm. It has since resolved, but he presents to the clinic for evaluation. An EKG obtained on arrival is unremarkable, but he soon develops chest pain again…

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Fall on Thinners: Management of Traumatic ICH in the ED

An 86-year-old female with past medical history of atrial fibrillation and coronary artery disease on apixaban and clopidogrel presents as a trauma activation after a mechanical fall from standing at her nursing facility. She does not remember the fall, but her nurse reports she tripped over her walker, fell and struck her head. She did not lose consciousness…

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LAST Chance to Verify That Dose

A 34-year-old male presents to the emergency department from his urologist’s office after exhibiting word-finding difficulty and confusion during an elective surgery. He had previously been feeling well and is otherwise healthy. Per discussion with his urologist, the patient reported continued discomfort during the procedure, so he was given additional lidocaine until his pain was sufficiently managed. He developed symptoms that progressed from dizziness to word-finding difficulty and confusion. It was subsequently noticed that he had accidentally been treated with 2% lidocaine without epinephrine instead of 1% lidocaine without epinephrine, thus doubling the intended dose…

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