**Figure 1:** Ultrasound of the bilateral Achilles tendon with notable findings of surrounding anechoic fluid collection (white arrow) and decreased tendon diameter of the affected side.

Ortho Pearls - Ankle Pain After Jumping

November 5, 2023

The Case:

A 32-year-old man with no past medical history presented to the ED with left posterior ankle pain after playing basketball. He stated he jumped and felt an immediate “pop” and pain in the posterior leg. He has been unable to ambulate due to the pain. On exam, he had a positive Thompson test on the left calf. Radiographs were negative for acute fracture, but point of care ultrasound (POCUS) demonstrated an Achilles tendon injury.

Megan Buranosky MD, Victoria Gonzalez MD, and Scott Sherman MD

PharmD Pearls - What weight does the ideal dose for Diltiazem carry?

November 3, 2023

Is weight-based dosing for IV diltiazem in atrial fibrillation better than fixed dosing in treating atrial fibrillation? And which weight do we use? Given diltiazem has a half-life of 3 to 4.5 hours, you’ll want to be sure the dose you give is right dose for the patient. Find out more in the following article.

Joanne Routsolias PharmD

**Figure 1.** Troponin-I trend for patient presenting with chest pain.

Cool County Cases - Myo My! A Curious Case of Chest Pain in the ED

October 27, 2023

The Case:

The patient is a 30-year-old female with no past medical history who presented with a complaint of chest pain that began 1 hour prior to arrival. She stated that the chest pain was on the left side, and it radiated all the way down her left arm and made her fingertips feel numb. She described the pain as a “heaviness.” The pain was accompanied by dyspnea on exertion. She denied nausea, vomiting, diaphoresis, fevers, and recent illness. She had no family history of cardiac disease. She denied all PE risk factors. She denied smoking, alcohol, and drug use.

Niyi Soetan MD

the County Consult