January 29, 2014

Posted by Andy Jagoda, MD in: Uncategorized , 19 comments

Late one evening, a 32-year-old woman is brought to your ED via EMS after her boyfriend found her slumped over in a chair. He states that they were arguing last evening and that she was quite upset. Her boyfriend provides a medical history significant for migraine headaches, and he knows that she is taking verapamil for the same. Her fingerstick glucose is normal, and she has a heart rate of 28 beats/min and a blood pressure of 74/36 mm Hg. Consider what the best initial step in management for this patient would be — Is there a role for GI decontamination? What about hemodialysis? read more

Case Conclusion — Urinary Retention Complications
January 6, 2014

Posted by Andy Jagoda, MD in: Uncategorized , add a comment

Case 1:

A quick physical examination revealed only a distended bladder for the 72-year-old man. A urethral catheter was placed, and 700 mL of urine was obtained, with much relief for the patient. Not forgetting the patient’s presentation and his stumble while changing stretchers, you decided to perform a thorough neurological examination, and you found nearly absent rectal tone and absence of sensation and vibration below T11. Urgent MRI confirmed your diagnosis of spinal cord compression. You consulted neurosurgery, and the patient was admitted for decompressive laminectomy and eventual chemotherapy. read more

Urinary Retention Complications
January 2, 2014

Posted by Andy Jagoda, MD in: Renal and Genitourinary Emergencies , 1 comment so far

Case 1:

It’s 2:00 PM and you are about to finally grab some lunch, but in comes a 72-year-old man with a history of large cell lymphoma for the past 15 years. He complains of dribbling urinary frequency, which has worsened over 1 day after being prescribed an antibiotic by his doctor for a UTI. The nurse asks him to walk to another stretcher, and as he gets up, he stumbles and catches himself with his hands. As you prepare to do the bladder ultrasound, you wonder why he stumbled… read more