Emergency medicine
Clinical teaching and practical ideas for your next study session.
Gustilo IIIB or IIIA? Let Periosteal Stripping Break the Tie
A 12-cm, soil-contaminated wound raises concern for a severe open fracture, but it does not decide the subtype. When a stem also describes substantial periosteal stripping with exposed bone, that points toward IIIB; learn what would favor IIIA or define IIIC.
Ottawa Ankle Rules: When a Negative Result Doesn't Apply
A patient who can walk may still need imaging—and the Ottawa Ankle Rules cannot clear every foot bone. Learn a scope-first method for interpreting this board-style question.
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.
Open-Fracture Antibiotics: Answer the SAQ Without Guessing the Grade
A strong open-fracture SAQ does more than list cefazolin, gentamicin, and penicillin. Separate immediate prophylaxis from a provisional injury grade, define the contamination risk, and name the protocol behind broader coverage.
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.
Septic Obstructing Stone: First-Hour Plan Beyond “Call Urology”
The mark-bearing move in an infected obstructing-stone SAQ is to name urgent drainage—not stop at “consult urology.” Learn how to start antibiotics and shock care while arranging a stent or nephrostomy, and why definitive stone removal waits.
Smoke-Inhalation Intubation: Which Three Findings Matter?
For inhalation-injury SAQs, distinguish evolving airway compromise from evidence of smoke exposure. Three defensible findings—and a focused retrieval drill—make the answer clearer.
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.
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.
Erythromycin Before Endoscopy: A Better View, Not Hemostasis
When a board stem asks which medication can improve the endoscopic view before upper endoscopy, the answer is IV erythromycin. The key distinction: better visualization is the goal; bleeding control still requires resuscitation and definitive hemostasis.
Anaphylaxis With Stridor, Shock, and Propranolol: Do Not Let Glucagon Delay the Airway
In suspected food-triggered anaphylaxis with stridor, hoarseness, tongue swelling, wheeze, and shock, the key ED decision is when to secure the airway while epinephrine treatment continues. This case-based framework separates upper- from lower-airway findings, clarifies what propranolol changes, and avoids common rescue-therapy traps.
When Septic Shock Looks Cardiogenic: A Bedside Framework for Mixed Shock in the ED
Fever, pulmonary crackles, cool skin, atrial fibrillation, and a high lactate can point in several directions. Learn to identify mixed shock without anchoring, overloading a failing heart, or delaying pressors and antibiotics.