Case Discussion
Clinical teaching and practical ideas for your next study session.
Febrile Neutropenia With a Port: How Paired Cultures Test the Source
Fever and neutropenia with a port do not identify the bloodstream source. Learn how paired port and peripheral cultures can help test catheter involvement without delaying antibiotics or needed source control.
After RSI for Status Epilepticus: Paralysis Is Not Seizure Control
A quiet body after rocuronium does not prove that status has ended. Learn why urgent EEG—not vital signs alone—guides further seizure treatment.
Aneurysmal SAH: Why SBP <160 Is Not a Universal Target
With an unsecured aneurysm, the ED goal is controlled blood-pressure management—not a reflexive drop to one cutoff. Learn how to balance rebleeding concern, cerebral perfusion, and timely definitive treatment.
Warfarin in Acute Stroke: Keep Reperfusion Moving While INR Is Pending
A warfarin history can hold IV thrombolysis until the INR is known. The ED decision is what continues in parallel: controlled BP management, vascular imaging, and thrombectomy evaluation.
Adrenal Crisis in the ED: Preserve the Test, Treat Now
The key ED decision is not how to force an ACTH stimulation test into resuscitation, but how to preserve diagnostic clues without delaying hydrocortisone for an unstable patient.
Thyroid Storm With AF and Crackles: Choose Beta-Blockade by Perfusion
In thyroid storm with AF and crackles, the key decision is not simply whether to use propranolol, but whether the circulation can tolerate beta-blockade. Learn how perfusion, cardiac assessment, and reversibility guide safer rate control.
After the Hyponatremic Seizure: Catch the Sodium Surge
A seizure may stop after hypertonic saline while sodium keeps climbing from a sudden water diuresis. Learn the urine-output clues, correction limits, and when to pause treatment or consider DDAVP and D5W.
Hemolyzed Potassium, Sine-Wave ECG: Treat First, Verify in Parallel
A hemolyzed potassium result does not settle the diagnosis in a dialysis patient with a dangerous ECG. Learn how to stabilize immediately while getting a repeat result you can interpret.
DKA and a Positive Troponin: Injury Is Not Yet an Infarct
In DKA, an elevated troponin signals myocardial injury but does not identify its cause. Learn how serial ECGs, assay-based troponin trends, and evidence of ischemia guide ED decisions about ACS.
Massive Hematemesis in the ED: When to Intubate—and When Not To
In massive upper GI bleeding, the airway decision turns on active emesis, the patient’s ability to clear blood, and mental-status trajectory—not simply the plan for endoscopy.
Aortic Dissection With a Changing Pulse Exam: Recognizing Malperfusion
A pulse deficit that fluctuates can be an evolving warning, not reassurance. Learn how serial neurovascular findings guide recognition of possible branch-vessel malperfusion, the CTA question, and urgent escalation—without guessing the exact artery from one bedside exam.
COPD Exacerbation Oxygen: Treat 84% Without Chasing 100%
How should the ED correct hypoxemia in hypercapnic COPD without withholding oxygen or over-oxygenating? Use an initial controlled target, read the blood gas, and reassess ventilation separately.