A 68 year-old man was sent by his PCP for evaluation of abnormal outpatient labs. He had been seen last week for back pain and malaise. We had a look at the labs and the diagnosis was there. Do you see it? What should the next test be?
Continue readingAuthor: Jeffery Steele
Bladder Ultrasound: part 3
In part 3 of our discussion about the uses of bladder ultrasound in the emergency department, we consider the case of a 70 year-old man with urinary retention in whom we were unable to place a urinary catheter.
Continue readingBladder Ultrasound: part 2
Part two in our three part series on bladder ultrasound. We will look at two cases.
Continue readingBladder Ultrasound: part 1
Something that I’ve got a lot of mileage out of recently is bladder ultrasound.
Continue readingTime Management
July brings new interns. They certainly have a lot on their plate, but seeing them work through their first shifts always reminds me that while they are learning how to practice medicine we depend on them to keep the patient flow moving – something most of them have never considered. Efficiency and flow management are skills that are learned. I’ll share my thoughts, even though I do not feel I am gifted in this area.
Continue readingRegional Wall Motion Abnormality
A 45 year-old man presents by EMS after a VF arrest. On arrival at the ED he has a pulse. An ECG shows an anterior STEMI. The cath lab is activated and the cardiologist is en route. While waiting for the cavalry to arrive, you ultrasound his heart and strike gold.
Continue readingA Tale of Two Clots
A thrombus in the heart is really the holy grail of point-of-care ultrasound. Here are two great examples.
Continue readingEye Can’t See!
A 23-year-old woman complains of painless vision loss in the left eye over the past two days. She has no past medical history. This one isn’t a diagnostic dilemma, but it does come with some nice imaging.
Why 0.14 units/kg/hr of insulin in DKA?
I recently reviewed the insulin dosing recommendation by the American Diabetes Association (and UpToDate) for the treatment of diabetic ketoacidosis. Both recommend either a 0.1 U/kg bolus followed by an infusion of 0.1 U/kg/hr or no bolus and 0.14 U/kg/hr. Where does such a bizarre number come from?
Which length dialysis catheter should I use?
Your patient needs emergent dialysis. To expedite the proceedings, you agree place the dialysis catheter. You look on the shelf, but there is more than one length of catheter. Which one do you grab? Do you know?
