Spidey Sense and the Art of Low Risk Chest Pain

As Emergency Physicians, one thing we particularly pride ourselves in is our “gestalt” or general sense about the patient. In a world where we have an extensive tool kit of diagnostic criteria and clinical decision making instruments we still occasionally throw those out the window when we get a sense of something else going on … Continue reading Spidey Sense and the Art of Low Risk Chest Pain

Retropharyngeal Abscess in an Adult

Case Presentation  A 53-year-old woman presents to the emergency department with three days of worsening dysphagia, odynophagia, and muffled voice. The patient is ten days status post adenotonsillectomy with inferior turbinate reduction for chronic tonsillitis and obstructive sleep apnea.  The patient tells her history by writing on a piece of paper since speaking is too … Continue reading Retropharyngeal Abscess in an Adult

To Dive or not to Dive

Introduction  Carbon monoxide (CO) poisoning results in approximately 50,000 emergency room visits per year. Further, it is the leading cause of death due to poisoning. When CO binds to hemoglobin it causes toxicity by creating carboxyhemoglobin (COHb). CO binds hemoglobin with 200 times greater affinity than does oxygen. Therefore, CO poisoning reduces the oxygen carrying … Continue reading To Dive or not to Dive

Psychogenic Polydipsia and the Case of Severe Hyponatremia

The Case The ambulance company calls in asking your emergency department to prepare for an agitated adult female with known psychiatric history.  Depending on where you work, this may involve having security at the ready with physical restraints and your best (strongest?) nurse with Haldol and Ativan in hand, for the patient’s safety and your … Continue reading Psychogenic Polydipsia and the Case of Severe Hyponatremia