A seven-day old male presented to the Emergency Department (ED) with twelve hours of increased work of breathing. His mother reported a healthy pregnancy and spontaneous vaginal delivery. She noted they had been home for 5 days from the newborn nursery. However, overnight she found the patient had increased work of breathing and difficulty with feeds. She noted he was no longer able to finish a full feed…
Read MoreA 57-year-old female presents to the emergency department with fatigue and weakness that have been worsening over a period of several months. She has a past medical history of chronic daily alcohol use, coagulation disorder with increased INR, and anxiety. She does not like to see physicians and has not been to her primary care doctor in several years, but decided to come in today because her fatigue and weakness have become too severe…
Read MoreA 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…
Read MoreThe overhead announcement goes off: “Team B to the trauma room”. The report: EMS is bringing a 2-year-old female that was found unresponsive in the family swimming pool by her mother after being alerted by an older sibling. Unknown downtime. The patient is being bagged by bag-valve mask (BVM) and has slow, but palpable, femoral pulses, she is unresponsive, ETA 2 minutes…
Read MoreAn 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…
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