A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Figure 1. Index ECG.
A 72-year-old male with a past medical history of hypertension, type 2 diabetes, hyperlipidemia, atrial fibrillation, coronary artery disease (CAD) with triple-vessel disease, heart failure with a known ejection fraction (EF) of approximately 30%, chronic mesenteric ischemia, and liver cirrhosis presents to the emergency department (ED) with complaint of bilateral lower extremity swelling.
Michael Hohl, MD
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Figure 1. Index ECG.
It’s 3:00 AM and the ER theme song wakes you from your Trauma swivel chair nap. “County, this is CFD. We’re bringing you an 11-year-old male who was a restrained passenger involved in a head-on motor vehicle collision going 45 miles per hour. Airbags deployed, and the patient was able to self-extricate. We’ll be there in 2-3 minutes.”
Michael Hohl, MD; Taylor Wahrenbrock, MD; Ari Edelheit, MD
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Figure 1. The four order set pathways for opioid and xylazine withdrawal. Based on severity of withdrawal, ability to gain IV access, and known or concern for prolonged QTc.
EMS brings in a patient who is reporting heroin withdrawal, so you reflexively give the patient an IV fluid bolus and Zofran, but he is now feeling worse. You try sublingual buprenorphine 8mg, and while the patient initially feels better, he is feeling even sicker a few hours later. What else may be going on? What other options are at your disposal to improve your patient’s symptoms?
Taylor Wahrenbrock, MD; Kathryn McGregor, MD; Eric Leser, MD; Michael Nelson, MD; Antonia Nemanich, MD
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