COPDE with Pneumothorax

A 68-year old man with COPD requiring home oxygen presents with respiratory failure. He is hypoxic, hypercarbic and agitated and will require intubation. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. After a successful intubation, the high pressure alarms on the ventilator will go off. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax.

Urologic Sepsis

Denise is a 59-year-old female who presents with a 7-day history of urinary symptoms, fever, and left flank pain. She has a history of STEMI 5 years ago with chronic left-sided heart failure. She becomes unstable in the ER, requiring judicious fluid resuscitation, vasopressors, and empiric antibiotic treatment. The team leader needs to consider the history and arrange renal imaging to discover the severe sepsis is secondary to an infected ureteric calculus. From there, emergent urologic consultation and admission to hospital is warranted.

Hypercalcemia of Malignancy

This case was written by Dr. Skye Crawford and Dr. Nathan Ashmead, academic emergency physicians at the University of British Columbia. Why it Matters Oncology patients often present a challenge to healthcare providers in the emergency department. They have complex medical needs, both from their underlying illness and from the surgical, medical and radiologic treatments … Continue reading Hypercalcemia of Malignancy

Unstable Atrial Fib

This case was written by Drs. Pittman and Bridges, emergency physicians at Prisma Health-Upstate in Greenville, SC.  They both teach in the University of South Carolina School of Medicine-Greenville and in the emergency medicine residency program.   Dr. Pittman is the residency Director of Academic Success, completed residency at the Georgetown / Washington Hospital Center Emergency … Continue reading Unstable Atrial Fib

Inhalational Injury

A 70-year old female is brought to the ED after lighting herself on fire while trying to light a cigarette. She will have a 15% TBSA burn (upper anterior chest and neck only) with inhalational injury. Preparation for intubation should be an early priority. Her prognosis is poor but survivable and it will be key to discuss goals of care with the family before proceeding with intubation and further burn care. A difficult intubation should be anticipated but is not encountered in this case.

COVID-19: STEMI with VF Arrest

This 50-year old woman presents with typical cardiac chest pain and high suspicion for COVID-19. Her ECG shows an anterior STEMI. The team will start performing the initial work-up and management of a patient with STEMI. While this is occurring, the patient suffers a VF arrest. The team will need to go through the ACLS algorithm while taking all precautions required in caring for a patient with suspected COVID.