Best Case Ever 33: Over-correction of Hyponatremia
Rapid over-correction of Hyponatremia can have devastating consequences: for one, osmotic demyelination syndrome (ODS) can result in destruction of the pons and a locked-in state. We don't see ODS very much as it's onset is delayed and usually sets in after the patient is admitted to hospital (or worse, sent home). Nonetheless, we need to know how to manage Hyponatremia in the ED so that we prevent ODS from ever happening. In this Best Case Ever, Dr. Melanie Baimel describes the case of a young woman who came in to the ED after drinking alcohol and taking Ecstasy, wanted to leave AMA after her Hyponatremia had inadvertently been corrected too rapidly, and the conundrum that ensued.
In the upcoming episode, Dr. Baimel and the first ever Internal Medicine specialist on EM Cases, Dr. Ed Etchells, discuss a rational step-wise approach to managing Hyponatremia, tailored for the EM practitioner; when you might consider giving DDAVP in the ED, the best way to correct Hyponatremia, how to manage the patient who's Hyponatremia has been corrected too quickly, and an easy approach to the differential diagnosis. Get a sneak peak at the algorithm that will be explain and review in the upcoming episode......
Best Case Ever 32 Carr’s Cases – Endocarditis and Blood Culture Interpretation
David Carr discusses his top 10 pearls on endocarditis and blood culture interpretation in this Carr's Cases Best Case Ever on EM Cases.
Best Case Ever 31: Andrew Sloas on Pericardiocentesis
On this EM Cases Best Case Ever, Andrew Sloas, the brains behinds the fabulous PEM-ED podcast tells the tale of a pericardiocentesis gone bad and what he learned from it. Emergency pericardicentesis can be life saving, but it also carries risks. Dr. Sloas reviews the steps to take to ensure that the pericardiocentesis needle is the the correct place to minimize the risk of intubating the right ventricle of the heart. A discussion of errors of omission and ones of commission follows. As in FOAMed, let the bubbles show the way....
Best Case Ever 30 Rob Rogers’ Mother
I caught up with my friend and education innovation mentor Dr. Rob Rogers
at ACEP in Chicago where he told me the tale of his mother's devastating illness - the only EM Cases occurrence of a second Best Case Ever. This powerful story begs many questions, some of which we discuss in the podcast: The importance of considering a lumbar puncture in the setting of altered mental status NYD, cognitive de-biasing strategies and the importance of being a humble patient advocate. We discuss a diagnosis that we should never miss in the ED, how to recognize it early, some pearls and pitfalls, as well as how to manage it effectively. We touch on how to recover from personal tragedy in anticipation of his upcoming SMACC talk in June 2015. Enough of this.....listen.
of herpes encephalitis
Life in The Fast Lane review
of herpes encephalitis
Postgrad Medicine review
of herpes encephalitis (full PDF)
Best Case Ever 29: Drug Induced Aseptic Meningitis
Dr. David Carr
presents his third of EM Cases' Carr's Cases. This series features potentially debilitating diagnoses that may be thought of as 'zebras', but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. Dr. Carr tells the story of young woman with an MRSA supra pateller abscess who was put on trimethoprim sulfamethoxazole and presents looking very ill with a severe headache.
Not only has trimethoprim sulfamethoxazole been implicated in aseptic meningitis, but NSAIDS, immunomodulators and antibiotics have also been implicated. The reason this is so important for ED practitioners to know, is that case reports of drug-induced aseptic meningitis have shown that symptoms will resolve completely within 24 hours, once the offending drug has been stopped. Not only that, but if the patient receives the drug again in the future, they are at risk for a more severe case of drug induced aseptic meningitis.
Dr. David Carr and Dr. Joel Lockwood's article on Drug induced Aseptic Meningitis in CJEM (prepublication)
Harrison MS, Simonte SJ, Kauffman CA. Trimethoprim induced aseptic meningitis in a patient with AIDS: case report and review. Clin Infect Dis 1994;19:431-4.
Joffe AM, Farley JD, Linden D, et al. Trimethoprim sulfamethoxazole-associated aseptic meningitis: case reports and review of the literature. Am J Med 1989;87:332-8.
Quick Links to Recent Emergency Medicine Cases Episodes
Entire EM Cases Library is Free Open Access
Episode 58 Tendons & Ligaments – Commonly Missed Uncommon Injuries P2 with Ivy Cheng & Hussein Mehdian
Episode 56 The Stiell Sessions 1: CDRs & Risk Scales with Ian Stiell & Hans Rosenberg
Episode 55 Weingart-Himmel Sessions 2 – Fluids in Sepsis & Post Intubation Sedation with Walter Himmel & Scott Weingart
Episode 54 Weingart-Himmel Sessions 1 – Preoxygenation & Delayed Sequence Intubation with Walter Himmel & Scott Weingart
Episode 53 Pediatric Point of Care Ultrasound with Jason Fischer, Alyssa Abo, Alex Arroyo & Adam Sivitz
Episode 52 Uncommon Commonly Missed Orthopedic Injuries with Ivy Cheng & Hossein Mehdian
Episode 51 Managing Difficult Patients with Walter Himmel, Jean Pierre Champagne & Ann Shook
Episode 50 Recognition & Management of Pediatric Sepsis and Septic Shock with Sarah Reid & Gina Neto
Episode 49 Effective Patient Communication, Patient Centered Care & Satisfaction with Walter Himmel, Jean Pierre Champagne & Ann Shook
Episode 48 Pediatric Fever Without a Source with Sarah Reid & Gina Neto