A 20-something year old unknown male is brought to your community ED in a wheelchair by friends. They were at a party and a fight broke out. It was loud and dark and then they saw the patient collapse. His low back is covered in blood. He is awake but moaning.
Lateral Canthotomy
A 25 y/o M pitching in a Sunday baseball game is hit in the face by a line drive. He is brought to the ED by his friends complaining of decreased visual acuity to his right eye accompanied by significant right peri-orbital swelling. At triage his VA is OD 20/100 OS 20/25 but at the time of assessment VA OD is limited to detection of light and his pupil is fixed and dilated, extra-ocular movements are intact. The team should recognize the need for lateral canthotomy based on the history and physical exam findings (including IOP) and mobilize the appropriate resources for bed-side lateral canthotomy as well as the need for emergent ophthalmology consult.
Late Post Partum Pre-eclampsia
Alice, a 20-year old female with no significant past medical history is brought in by ambulance with worsening upper abdominal pain onset 1 week ago when she woke up. She has felt nauseous and has vomited one time this morning. Two days ago, she began to feel short of breath. She states that it has been getting worse and she is now having trouble lying flat. She was hypertensive with EMS.
Introducing SimLab
This post comes to us from Dr. Tristan Jones who is an Emergency Physician working in Victoria, BC, Canada. He completed medical school in Calgary, and EM residency in Victoria through the University of British Columbia Island Program. Prior to medicine, he studied electrical engineering, and has been programming and developing software for over 20 … Continue reading Introducing SimLab
COVID-19: Difficult Airway
Mr. Johnson, a 60-year old man was found at the bottom of 3 steps at home by his wife. He is obtunded with obvious bruising to head. EMS has placed him in a C-spine collar and provided supplemental oxygen. He was swabbed for COVID yesterday due to a new cough and fever and the results are still pending.
Tracheoinnominate Artery Fistula
This case was written by Dr. Brandon Evtushevski. Dr. Evtushevski is an Emergency Medicine resident at the University of British Columbia, Vancouver Island Site. Prior to this, he completed a BSc in Neuroscience at McGill University followed by his MD at the University of British Columbia. He has interests in neurologic emergencies, critical care and … Continue reading Tracheoinnominate Artery Fistula
Cocaine-induced Aortic Dissection
This 49-year old male had abdominal and chest pain that start while smoking cocaine. This is on top of a history of untreated hypertension. On exam, he has signs of aortic dissection and requires stabilization before going to the CT scanner. Upon arrival back from the CT scan (which confirms the diagnosis of Type A aortic dissection) the patient is altered and in shock. Assessment reveals the patient to be in cardiac tamponade requiring emergent pericardiocentesis.
Pediatric Polytrauma
A 2.5 year old child falls from the 3rd floor balcony and presents to a community hospital. The team is expected to coordinate a thorough trauma survey. The patient will initially demonstrate compensated shock requiring aggressive resuscitation. After this initial phase, findings of severe head injury will become apparent. The team must optimize the patient for transfer to definitive care.
Pediatric Asthma Exacerbation
Acute asthma exacerbations in children are extremely common. Most asthmatic exacerbations respond quickly to basic treatment with beta-agonists, anticholinergics, and steroids. This case highlights the management of those patients who need treatment that goes beyond the basics.
Beta Blocker Toxicity
A 44-year-old male presents to the emergency department following the ingestion of an entire bottle of metoprolol. Decontamination strategies should be utilized alongside consultation with poison control. Patient clinically deteriorates as the drug reaches peak effects, requiring IV fluids, atropine, calcium, glucagon, multi-dose vasopressors, high dose insulin, and a discussion around potential salvage therapies.
