Medical Education
Clinical teaching and practical ideas for your next study session.
Negative Urine Pregnancy Test, New Hypotension: Keep Ectopic in Play
A negative urine hCG lowers—but does not erase—the chance of pregnancy. When a patient with abdominal or pelvic pain becomes hypotensive and pale, learn when to send serum β-hCG, what bedside ultrasound can show, and why evaluation for bleeding must continue in parallel.
AFE vs Massive PE: Why Early Coagulopathy Matters
In peripartum collapse, amniotic fluid embolism and massive pulmonary embolism can both cause hypoxemia, shock, and right-heart strain. Early overt DIC before blood loss is sufficient to explain it favors AFE—but is not diagnostic by itself.
Intubated COPD: When to Tolerate Hypercapnia Instead of Chasing PaCO₂
After intubation for severe COPD, the key question is not how fast to normalize PaCO₂, but whether pH, baseline compensation, and clinical trajectory make permissive hypercapnia safer than more ventilation.
Septic Patient Transfer for Capacity: Regional Load-Balancing
Moving a septic patient to free a hospital bed is regional patient load-balancing, not intrahospital expansion. Learn how to distinguish an external alternate-care site from another hospital—and why the surge label does not establish that transfer is safe.
ARDS on Chest X-Ray: Bilateral Opacities Are a Clue, Not the Diagnosis
In ARDS, bilateral opacities are the key imaging pattern—not a standalone diagnosis. Learn why patchy films can qualify, what the imaging criterion excludes, and why absent cardiomegaly does not prove noncardiogenic edema.
Seven Bedside Teaching Questions: Find the Reasoning Gap
The seven prompts are not a checklist to fire at every learner. Use them selectively to locate a reasoning gap, distinguish diagnosis from action, and give one useful feedback point during an ED shift.
HELLP at 34 Weeks: Why BP 155/95 Doesn’t End the Workup
A BP of 155/95 is below severe range, but it does not close the HELLP evaluation in a 34-week patient with epigastric pain. Learn when to repeat labs and escalate.
US Navy Treatment Table 6: Depth, Oxygen, and Timing
When recompression is indicated for decompression illness, the standard U.S. Navy Treatment Table 6 starts at 60 fsw (2.8 ATA), uses timed oxygen periods and air breaks, then ascends in stages. Learn how to read the schedule—and what the 4-hour-45-minute figure includes.
Pediatric Hemorrhagic Shock: When 10 mL/kg PRBC Is Not Enough
In a child with suspected traumatic hemorrhage, 10 mL/kg of packed red blood cells may be a reasonable initial dose—but ongoing bleeding may call for a pediatric massive-transfusion pathway, not repeated RBC-only boluses.
Pregnancy and Carbon Monoxide Poisoning: Why a Maternal COHb of 12% Isn’t Reassuring
A maternal COHb of 12% is not a fetal COHb measurement. Learn why pregnancy changes how the result should be interpreted, what fetal assessment can show, and why an early hyperbaric consultation matters.
High LAMS, Low Certainty: Turning Motor Deficits Into an LVO Hypothesis
A high LAMS raises concern for proximal anterior-circulation ischemia, but motor severity alone cannot distinguish LVO from lacunar stroke, hemorrhage, or mimic. Learn the exam clues that convert a screening score into an ED imaging and triage decision.
When the Speculum Exam Stops: How to Finish the ED Evaluation Without Repeating the Assault
When a patient withdraws consent for a speculum exam, the next move is not persuasion. This ED framework shows how to separate urgent medical care, forensic options, prophylaxis, documentation, and follow-up so one declined component does not end the encounter.