Not every runny nose is a viral URI. This case presents a relatively immunocompetent HIV+ male presenting with left sided rinorrhea and a fungal sinusitis diagnosed by CT. We also discuss diagnostic and therapeutic strategies for this rare diagnosis
Read MoreIt’s that time in every Emergency Department: the academic year has come to a close. In our shop, interns are spending their last few shifts in B Pod, and the R2s are testing their taming skills in the SRU. The R3s are stepping up to the educator role, and the R4s are looking onward to their future careers. We spend these last few weeks balancing the excitement of our transitions and the purpose of our job: somewhere between the hustle and noise of B Pod, there is a critical illness waiting to be found, #beneaththesurface.
Read MoreFingertip injury is a common presentation with a lot of practice pattern variation. we tapped the guru himself, Dr. Trott, to teach us the latest in caring for nailbed injuries.
Read MoreA woman in her 50s and a history of uncontrolled diabetes presents with a draining wound from her heel. Your first thought should be this... Read on for an update on the latest information on the diagnosis and treatment or necrotizing faciitis.
Read MoreA male in his 30s came in after trying to break up a fight in a bar. No good deed goes unpunished, but what is wrong with this knee?
Read MoreWhile many wounds are adequately repaired with simple interrupted sutures, not infrequently we are confronted with wounds that require more specialized suturing methods. One such method is deep sutures. Here to answer some questions regarding deep sutures is our wound management guru, and author of the book “Wounds and Lacerations: Emergency Care and Closures,” Dr. Alexander Trott.
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The patient is a 74 year-old African-American female with a history of hypertension, coronary artery disease status post drug-eluting stent ×1, former cigarette smoker, and iron deficiency anemia presenting with left-sided vision loss. Patient states that approximately two days ago she woke up with painless peripheral vision loss of her left eye only. She describes it as darkness in the lateral portion of her left eye. She reports that her vision returned to baseline throughout that day; only to return when she awoke the next morning. Since that time she endorses persistent vision loss in the left periphery. She denies blurry vision, eye pain, headaches, recent trauma, flashes, and floaters. Furthermore, she also denies dizziness, numbness weakness, dysarthria, dysphagia, fever, chills nausea, vomiting, chest pain, shortness of breath, and palpitations. She reports adherence to her antihypertensive and anti-platelet medications...
Read MoreImagine it’s your first moonlighting shift at a small rural community hospital. The nearest referral center for both adults and children is 90-minutes away by ground. The annual census of the emergency department is 15,000 patients per year, of which only 5% is pediatric. There are 2 hours left in your 12-hour shift and your energy is all but spent. You are looking forward to winding down at home after an extremely busy and high-acuity shift when your 35th patient of the day checks in. The patient’s chief complaint is fever. You give yourself an internal fist pump thinking that you’re about to see your 12th viral URI of the day and that you’ll be in-and-out of that room no in time. In the midst of your premature celebration you scan the nursing note and see the age of the patient: 6 weeks…You’re hopes of a quick and easy disposition suddenly melt away leaving you with many more questions regarding this patient’s care than answers…You muster your remaining energy and make your way toward the patient’s room.
Read MorePatients typically present to the Emergency Department with one complaint. The chart says “Headache” or “Abdominal Pain” but B-pod implores us to look closer. B-pod teaches us that it is our job to sit down, take a few extra minutes, and look at the entire patient in front of us...
Read More1. Find your Tonopen. At our shop the Tonopen lives in the cabinet in the attending office.
2. Adequate corneal analgesia is key. Instill tetracaine in both eyes prior to using the Tonopen.
3. If you are assessing the patient for corneal abrasions, perform the fluorescein exam prior to using the Tonopen as the Tonopen may inadvertently cause small abrasions.
4. Place a cover over the tip. It slides on like a condom and then roll the ridge into the grove.
Read MoreThe patient is a male in his 40s who presents after sustaining an injury to his right eye with a fishing hook. He states that a three-barbed hook pierced his eye while fishing with his friend. On gross inspection, the hook was noted to have pierced the inferior eyelid causing an obvious right open globe and there was a large hyphema. While he was initially able to count fingers at four feet in his superior visual field, his visual acuity quickly deteriorated to light perception only. Extraocular movements were intact and caused movement of the hook. Ophthalmology was consulted and a CT was obtained. The patient was then taken to the OR for anterior chamber washout, open globe repair, and removal of the fish hook. He was discharged following the surgery with next day follow-up with ophthalmology.
Read MoreThe patient is a female in her 60s who presents by EMS after a fall in a parking lot approximately one hour prior to arrival. She fell forward and landed on her face. She believes she simply tripped and fell, but she did lose consciousness and does not know how she ended up on the ground. Per family, she is unsteady on her feet and falls frequently, requiring a cane at baseline. She reports feeling “weak” but no other symptoms preceding her fall. She presents with significant right-sided facial trauma and is unable to open her right eye. She has no complaints of blurry vision in her left eye. She has no headache or other areas of pain or trauma.
Read MoreSometimes an issue’s theme is evident from the beginning- a well planned coordination of cases and perspectives that delivers a set message. Other times, an issue’s theme develops itself over the course of publishing the issue- a common thread manifests itself to us as editors as the issue comes together. Every so often, as was the case with this issue, AOBP ends up like a B-pod shift itself- a glimpse of the vast and varied pathophysiology that can present to us as Emergency Physcians at any point.
Read MoreThe patient is a male in his 20s who was playing soccer and felt a pop in his left knee followed by pain in his left knee. He has not been able to ambulate since the injury. He has an obvious deformity to the lateral aspect of his left knee. His x-ray was read as normal. Given his pain and mechanism, there was concern for fibular head dislocation so a CT of the knee was ordered. This showed an anterior, inferior subluxation of the fibular head.
Read More#lessonslearned is a case series submitted by former senior residents describing B-pod cases that taught them the art of medicine
A male in his 30s with a past medical history significant for hypertension presented via EMS with pain all over, anxiety and shortness of breath. The EMTs reported that he had smoked marijuana about 30 minutes before his presentation from his normal supply. At the scene he was noted to be very agitated, diaphoretic and vocal about his pain. He was yelling that he was hurting all over, he was having trouble breathing, and that he wanted to be sedated. He states that he has never had problems like this.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
