**Source:** https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome#/media/File:ARDSSevere.png

The Cheese - Corticosteroid Use in Sepsis, ARDS, & CAP

October 4, 2024

A 78-year-old female presents with dyspnea, and her chest x-ray demonstrates signs concerning for community-acquired pneumonia (CAP). Despite your best interventions, her oxygenation and work of breathing are worsening, so you call Respiratory Therapy to initiate high-flow nasal cannula. Meanwhile, you’re left thinking, “Would steroids help turn her around? But what are the guidelines - are steroids best used for CAP or sepsis or both? What kind of CAP? When and how much?”

Taylor Wahrenbrock, MD; Kathryn McGregor, MD; and Eric Leser, MD

The Heart of the Matter - ED Referral for Hypertension

September 27, 2024

A 68-year-old female with a past medical history of untreated hypertension was referred to the ED from an outside clinic for hypertension. She had been off antihypertensive medications for several months and had attempted to re-establish care with a PCP but was referred to the ED for a blood pressure of 200/120. At triage, she denied any symptoms. An ECG was obtained at 15:22, when the patient was asymptomatic.

Iris Lawson-Seebaran, DO

**Source:** http://www.svuhradiology.ie/case-study/mediastinal-widening-cxr/

The Cheese - A Predictive Clinical Tool for Aortic Dissection

September 20, 2024

Picture the following encounter: A 52-year-old male presents with chest pain. He seems comfortable and is slightly hypertensive to 156/83, but the rest of his vital signs are normal. He admits to using cocaine prior to the onset of chest pain. He denies any radiation of pain or other associated symptoms. When you are going through your differential, you consider aortic dissection, and you wonder if there are any tools to help you decide if this patient should get a CT angiography (CTA) study to further evaluate for aortic dissection.

Taylor Wahrenbrock, MD and Kathryn McGregor, MD

the County Consult