Black Pleural Effusion
Pleural aspiration from a 56-year-old man, who presented with a massive right pleural effusion, yielded purely black coloured fluid. This fluid was determined to be an exudate with very high…
Blue–black eyes and legs
A 70-year-old woman presented with asymptomatic blue-black discoloration of her legs and sclerae. She had a history of oxacillin-resistant coagulase-negative staphylococcal endocarditis complicated by aortic root abscess, needing surgery and…
Nail Sign observed in a 19 year old man
A 19-year-old man presented with pedal oedema and facial puffiness of 3 months' duration. He denied history of orthopnoea, paroxysmal nocturnal dyspnoea, oliguria, haematuria, fever, sore throat, joint pains, rashes, exposure to heavy metals, or any drug abuse.
Hyperphosphatemia and Hypophosphatemia: Clinical Features and Management
Hypophosphatemia - Causes
Hyperphosphatemia Hyperphosphatemia is defined as a serum level above 2.5 mg/dL, but it is usually clinically significant only when levels are greater than 5 mg/dL. Although it is rare in…
Shock Algorithm
Shock Algorithm
The goal for the patient in shock is rapidly identifying that the patient is in shock, finding the cause of shock and treating the cause while simultaneously resuscitating the patient.…
Diagnosing and Treating Meningitis
Infectious meningitis can be caused by a variety of bacterial, viral, fungal, and parasitic organisms. Bacterial and viral organisms account for the most common types of infectious meningitis...
Reversal of Anticoagulant Therapy
Anticoagulants Reversal Agents
A classic scenario of life-threatening hemorrhage requiring emergent anticoagulant reversal is that of intracranial hemorrhage (ICH). We extrapolate recommendations for other hemorrhages from this often-studied patient group...
Recognizing and Treating Thyroid Storm
Thyroid storm is an extreme version of hyperthyroidism with a mortality rate that approaches 30%, even with treatment. The recognition and management of thyroid storm can be difficult in the…
Approach to Undifferentiated Circulatory Shock
Circulatory Shock - Differential Diagnosis
The patient in Undifferentiated Circulatory Shock presents a unique challenge for the emergency physician, as the provider must perform time-critical resuscitation with limited diagnostic information. In addition to a focused…
Appropriate Antibiotics for Resistant Organisms
Some mechanisms of resistance to antibiotics
Antibiotics are prescribed to ~15% of emergency department (ED) patients and are among the most frequently utilized medications in emergency medicine. Often, the emergency provider (EP) must make clinical decisions…