Patients typically present to the Emergency Department with one complaint. The chart says “Headache” or “Abdominal Pain” but B-pod implores us to look closer. B-pod teaches us that it is our job to sit down, take a few extra minutes, and look at the entire patient in front of us...
Read More1. Find your Tonopen. At our shop the Tonopen lives in the cabinet in the attending office.
2. Adequate corneal analgesia is key. Instill tetracaine in both eyes prior to using the Tonopen.
3. If you are assessing the patient for corneal abrasions, perform the fluorescein exam prior to using the Tonopen as the Tonopen may inadvertently cause small abrasions.
4. Place a cover over the tip. It slides on like a condom and then roll the ridge into the grove.
Read MoreThe patient is a male in his 40s who presents after sustaining an injury to his right eye with a fishing hook. He states that a three-barbed hook pierced his eye while fishing with his friend. On gross inspection, the hook was noted to have pierced the inferior eyelid causing an obvious right open globe and there was a large hyphema. While he was initially able to count fingers at four feet in his superior visual field, his visual acuity quickly deteriorated to light perception only. Extraocular movements were intact and caused movement of the hook. Ophthalmology was consulted and a CT was obtained. The patient was then taken to the OR for anterior chamber washout, open globe repair, and removal of the fish hook. He was discharged following the surgery with next day follow-up with ophthalmology.
Read MoreThe patient is a female in her 60s who presents by EMS after a fall in a parking lot approximately one hour prior to arrival. She fell forward and landed on her face. She believes she simply tripped and fell, but she did lose consciousness and does not know how she ended up on the ground. Per family, she is unsteady on her feet and falls frequently, requiring a cane at baseline. She reports feeling “weak” but no other symptoms preceding her fall. She presents with significant right-sided facial trauma and is unable to open her right eye. She has no complaints of blurry vision in her left eye. She has no headache or other areas of pain or trauma.
Read MoreSometimes an issue’s theme is evident from the beginning- a well planned coordination of cases and perspectives that delivers a set message. Other times, an issue’s theme develops itself over the course of publishing the issue- a common thread manifests itself to us as editors as the issue comes together. Every so often, as was the case with this issue, AOBP ends up like a B-pod shift itself- a glimpse of the vast and varied pathophysiology that can present to us as Emergency Physcians at any point.
Read MoreThe patient is a healthy 3 week old male with no past medical history. He was born full term via uncomplicated Cesarean Section who presents with increased fussiness. His mother states the patient has simply not been acting like himself. He was taken home on hospital day 1 without issues, but in the last 24 hours, he has been quite fussy. His mother became concerned when he was unable to take his bottle today. The child has been refusing to eat and has been increasingly difficult to console. He has also had less wet diapers than normal today. Mom has not noticed cyanosis during feeding, recent illnesses or fevers. She also denies the presence of emesis, diarrhea, rashes, congestion, or cough.
Read MoreThe patient is a multiparous female in her 20s, post-operative day 8 from an uncomplicated repeat low transverse cesarean section at 39 weeks gestation after an uncomplicated pregnancy, who presents with SOB. She was discharged home on post-operative day 2 with a healthy female infant. She returns today with complaints of shortness of breath for 3 days and swelling in her bilateral lower extremities for 6 days. Over the same time course she endorses orthopnea, paroxysmal nocturnal dyspnea, weight gain, and chest pain. She describes the chest pain as substernal and intermittent. She also feels as if her chest is making a crackling noise when she exhales. She denies fevers, cough, nausea, vomiting, headache, or abdominal pain. She reports that her incision is healing well. She denies pain or drainage from the incision. She is breast-feeding her daughter, who is doing well at home. She has not yet seen her Obstetrician in follow-up but did receive all appropriate prenatal care.
Read MoreThe patient is a male in his 20s who was playing soccer and felt a pop in his left knee followed by pain in his left knee. He has not been able to ambulate since the injury. He has an obvious deformity to the lateral aspect of his left knee. His x-ray was read as normal. Given his pain and mechanism, there was concern for fibular head dislocation so a CT of the knee was ordered. This showed an anterior, inferior subluxation of the fibular head.
Read MoreIn July, the entire emergency department is full of firsts; firsts shift in a new pod, first solo flights, first successful codes, and first shifts supervising new providers. This is an exciting time -- full of new faces and new roles. July can also be scary. All of those new roles come with uncertainty, fear of the unfamiliar, and immense responsibility.
This issue features cases and #lessonslearned from graduates whose “firsts” were not so long ago. These are showcased to serve as a reminder to us all that although this month is full of firsts for the residents, our faculty, nurses, and department have seen many Julys pass and are ready and eager to teach us their own #lessonslearned. Check out the new issue to see!
#lessonslearned is a case series submitted by former senior residents describing B-pod cases that taught them the art of medicine
A male in his 30s with a past medical history significant for hypertension presented via EMS with pain all over, anxiety and shortness of breath. The EMTs reported that he had smoked marijuana about 30 minutes before his presentation from his normal supply. At the scene he was noted to be very agitated, diaphoretic and vocal about his pain. He was yelling that he was hurting all over, he was having trouble breathing, and that he wanted to be sedated. He states that he has never had problems like this.
Read MoreWho gets antibiotics in COPD? Does that back pain patient have discitis? What causes pancytopenia anyhow? Answers to these questions and so many more in this months issue of Annals of B-Pod. Click on the image below for the full pdf.
Read MoreThis season's issue of Annals of B Pod we highlight clinical cases from our ED's B Pod to feature some complex cases starting with simple chief complaints, emphasizing the point that the sickest patients evolve from the mundane. Flu season continues to plague us and every day we face the question of how far to take the clinical evaluation when we see generic complaints. The decision comes partly from objective data, partly clinical decision rules, and mostly from a non-quantifiable summation that is clinical gestalt.
78 year old male with past medical history coronary artery disease status post stenting, hypertension, hyperlipidemia, chronic kidney disease presents with a chief complaint of double vision, feeling off balance. Patient states he awoke this morning with double vision. He states this sensation of double vision is worse when he looks side to side, and completely resolves when he closes one of his eyes. He does not wear glasses or contacts and denies any eye pain or trauma. Also, since this morning he has felt somewhat off balance, however denies any focal numbness or weakness of extremities. He noted an episode of slurred speech approximately 1 hour prior to arrival that has since resolved. No other difficulties with word finding or language. Otherwise patient denies headache, head trauma, neck pain, chest pain, or shortness of breath. He has not had symptoms like this in the past.
Read MoreDifficulty Swallowing
The patient is a 22 year old female with no significant past medical history who presents to the ED with a chief complaint of dysphagia. The patient first noticed difficulty swallowing solid foods 2 weeks ago. She states that she felt like food was getting caught in her throat. Initially she only had difficulty swallowing solid foods and was able to eat soft foods and liquids. However, she reports that over the course of two weeks her condition gradually worsened to the point where she could no longer tolerate fluids. She states that she has pain in the back of her throat when she attempts to swallow.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
