By Anna Healey, MD
Emergency Medicine Resident

Case: A 20 year old female was brought in by EMS after being found combative on the street.  She is agitated, violent, and yelling nonsense.  Initial vital signs are HR 165, BP 170/99, T 101.4, RR 24, O2 sat 60%.  After applying oxygen, the patient's saturation improves to 90% but she then has a generalized tonic-clonic seizure.  She is intubated for airway protection and hypoxia.  

Laboratory workup indicates acute renal insufficiency, elevated LFTs and acidosis.  Her acetaminophen/aspirin levels are negative and her EKG shows only sinus tachycardia with normal intervals.  Her boyfriend then presents to the ED, stating "all she did was take a tab of Molly tonight".

Meaghan Mercer, DO
Emergency Medicine Resident 

35 year old male presents to the ED after an MVC ejection. The patient has a GCS of 4 on arrival and is immediately intubated. The patient has equal pupils and facial and chest abrasions. The patient is initially tachycardic with a HR of 115, normotensive, and saturating well on the ventilator. An bedside ultrasound shows no PTX and is FAST neg. While waiting for your CT an EKG is obtained. 

What is your diagnosis?

by Travis Grace, MD
Emergency Medicine Ultrasound Fellow


A 61 year old male presents with left sided chest pain and vague abdominal “burning” in the midline. Symptoms have been present and worsening for several weeks now and nothing exacerbates or relieves them. He denies other symptoms like SOB, diaphoresis, N/V, back pain, arm pain, or flank pain. He has no GI or GU complaints. He does have a history of poorly controlled hypertension. He is well-appearing and stable on exam with only mild abdominal tenderness.  The following ultrasound images were obtained:

by Sean Weaver, DO MPH
Emergency Medicine Resident

Health Affairs has dedicated their entire December issue to issues surrounding emergency medicine.  The reason for a theme issue focused on emergency medicine?  As Founding Editor John Inglehart says in his article “Mission Versus Reality in Emergency Care”:

“Emergency departments seem like orphans in the US health care system, with few strong allies among policy makers; as an afterthought in the Affordable Care Act; and, until recently, largely overlooked by agencies that fund research. … This thematic issue of Health Affairs focuses on emergency care, long popularized by television dramas but less recognized for the array of activities in which practitioners are engaged.”

Journal Club Review


Therapeutic hypothermia became the standard of care quickly when advance life support (ALS) task force issued the statement “Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF).” This was based off of two studies published in 2002 and was recommended internationally in 2010 although some said the evidence was weak. Therefore, researchers in Europe looked to gather more data. 

This is an international randomized trial of 950 patients that had out of hospital cardiac arrest with ROSC regardless of rhythm. The study aimed to evaluate if there was a difference in patients cooled to 33°C versus patients strictly kept at 36°C with a goal of preventing fever in both subgroups. 

Primary outcome: mortality by the end of the trial
Secondary outcome: neurologic outcome at 180 days using the CPC scale and modified Rankin scale

By Tony Zitek, MD
Emergency Medicine Resident

The Case:
A 79-year-old diabetic male presented to our emergency department with 10 days of progressive generalized weakness.  The patient was unable to give any other specific complaints.  His exam was notable for tachycardia to the 110s, and some suprapublic tenderness.  The finger stick glucose performed in triage was elevated. Metabolic panel revealed a glucose of 777, a bicarb of 12 and an anion gap of 18 with a BUN of 75 and a creatinine of 4.3.  Patient did not have a history of renal insufficiency. Urinalysis was consistent with urinary tract infection.  Patient was given 2L of normal saline, started on an insulin drip and given ceftriaxone. 

After 2L of IV fluids patient had almost no urinary output.  


What single bedside test could determine the cause of this diagnosis?