An 8-year-old boy presents to the ED after falling at a local playground
July 30, 2019


Posted by Andy Jagoda in: Uncategorized , 2 comments

An 8-year-old boy presents to the ED after falling at a local playground. His mother, who was with him at the time of the injury, states that he was climbing out of a tree when he slipped and fell. He landed on his outstretched hands and is now complaining of right wrist pain. On examination, he has no open wounds, and he has a normal neurovascular examination, but he has an obvious deformity of his right forearm. The child describes his pain as 7/10. read more

How best to assess his anticoagulation status
July 29, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , add a comment

As you begin your shift, the first patient is a 70-year-old man brought in for a ground-level fall with isolated head injury. A review of the patient’s history reveals atrial fibrillation, and he is currently on anticoagulation with apixaban. A rapidly obtained CT scan of the head shows
a subdural hematoma. read more

Most Common Risk Stratification Criteria for Management of Febrile Young Infants
July 18, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

Due to an immature immune system and pathogens often specific to the age group, the young infant (generally aged < 60-90 days, depending on the specific study or review) is at high risk for serious bacterial infections (SBIs); in particular, urinary tract infection (UTI), bacteremia, and bacterial meningitis. Consequently, the febrile young infant with a rectal temperature ≥ 38°C (100.4°F) is commonly encountered in the emergency department (ED). The incidence of SBI in febrile infants aged < 90 days is 8% to 12.5%, and it is nearly 20% in neonates (aged ≤ 28 days). The incidence of potentially life-threatening bacteremia and/or bacterial meningitis (ie, invasive bacterial infection [IBI]) is approximately 2%. read more

Intravenous Thrombolysis in Acute Ischemic Stroke
July 17, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

Stroke is the fifth leading cause of death in the United States and an important cause of long-term disability. Approximately 795,000 people suffer from stroke each year (610,000 primary strokes and 185,000 recurrent strokes),1 with ischemic stroke representing the vast majority of all stroke types (87%). read more

Brain Teaser: What is the appropriate management of this infant?
July 17, 2019


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Test your knowledge and see how much you know about management and treatment of young infants presenting with fever.

read more

Test Your Knowledge on Assessing Abdominal Pain
July 17, 2019


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Patients with abdominal pain are common in the ED, but you need a strategy for quickly identifying patients who are at high risk for life-threatening causes of pain. read more

Febrile Young Infants In the ED — How do you Manage them?
July 11, 2019


Posted by Robin Wilkinson in: Uncategorized , 4 comments

Case Recap:
A 40-day-old girl presents to the ED in January for evaluation of a rectal temperature of 38˚C (100.4˚F). The history and physical examination are similar to an infant you saw in August, except that she has nasal discharge and a cough. Which risk stratification algorithm should you use for this infant? Would your workup change if a respiratory swab was positive for respiratory syncytial virus? read more

How Do You Manage Bariatric Surgery Complications?
July 11, 2019


Posted by Robin Wilkinson in: What's Your Diagnosis , 2 comments

Case Recap:
You are called to the bedside of patient who presents for nausea and vomiting. He is a 38-year-old man who is 2 weeks out from the placement of a laparoscopic adjustable gastric band. He reports that he had an acute onset of nausea and vomiting this evening. He is actively vomiting on presentation and complains of diffuse abdominal pain, but is hemodynamically stable. While attempting to contact his surgeon, you wonder what the best imaging modality is to make the diagnosis. What would you do? read more