Case: A 18-year-old male with no medical history presents to the emergency department (ED) complaining of “feeling like I am having a heart attack” which started suddenly 1 hour ago. The patient ate from a food truck the night before and developed several episodes of forceful vomiting prior to arrival in the ED. What finding in this chest radiograph aids in the diagnosis? Click on image for a larger view.
In this new installment in the “How I Work Smarter” series, we feature Dr. Rob Mac Sweeney (@CritCareReviews), who is the editor for the prolific and very popular blog Critical Care Reviews. Twitter fans nominated him: “Everyone would like to know how you manage to produce such a resource and find the time to breath!” and “Rob never sleeps. Can be no other explanation!” Rob has agreed to share his trade secrets on how he works smarter and seeming finds more time in the day than us mere mortals.
“Late that afternoon, Quentin jogged along the Crissy Field promenade without paying much attention to the dogs frolicking on the beach or the windsurfers leaning low on their boards off Fort Point. Since Ralph was on call and not coming home, he reheated leftover spaghetti for his dinner and curled up on their bed with a textbook to study the surgical management of hip fractures. He would have liked to read about the nonsurgical management of hip fractures as well or, more important, about how to approach patients who can’t talk, or what to do when you’ve made an inexcusable mistake, but his book didn’t have chapters on those topics.”
- A History of Present Illness , Louise Aronson
A 6-year-old male is brought to the emergency department (ED) after falling from the monkey bars at a local playground. Physical examination reveals no scalp hematoma, and the child appears alert and well oriented. You decide to observe him over the next 30 minutes hours to determine if he develops any disconcerting symptoms. After 15 minutes of observation within the ED the patient has an episode of vomiting witnessed by the nurses. The patient’s mother wants to know if this means he has failed his observation period and needs to receive a head CT. Your answer?