Emergency Medicine News

Journal Logo


Loice Swisher, MD

Dr. Loice Swisher’s daughter had five episodes of unexplained vomiting without a fever in just one month during 1999. Thinking through the files in her mind, she was unable to shake the memory of a young child with the same complaint 12 years before. The well-looking child had been bounced out of the ED four times with "viral syndrome" and "gastroenteritis." The diagnosis was a posterior fossa tumor.

“How did this happen?” she asked. The attending shrugged, offering up various possibilities. It was a difficult diagnosis because the symptoms at first are nonspecific. It is uncommon. The prior docs probably didn't get her up to walk or look in her eyes. They probably didn't think of it. He concluded, "To an ER doc, unexplained vomiting is a brain tumor until proven otherwise."

That single phrase altered the course of her life. A "reassurance MRI" showed a 5 cm brain cancer, a medulloblastoma. Her daughter navigated a course of radiation, chemotherapy, and multiple complications, and Dr. Swisher started an entirely new medical education in the art of diagnosis.

Amal Mattu, MD, reminds those of us in emergency medicine to be on the lookout for lions and tigers and bears, not horses and zebras, Dr. Swisher explained. As an emergency physician and mother, she knows the profound impact this approach has on a patient's life. Using real cases, this blog aims to expose the lions and tigers and bears out there ready to bite.

Latest Entry: 6/1/2023 June 2023: Preventing a Clean Kill

Larry Mellick, MD
The M2E Too! Blog by Larry Mellick, MD, presents important clinical pearls using multimedia.

By its name, M2E Too! acknowledges that it is one of many emergency medicine blogs, but we hope this will serve as a creative commons for emergency physicians.

Latest Entry: 3/31/2023 April 2023: Cervical Injections for Headache and Orofacial Pain

Alissa Katz
Read breaking news and articles published ahead of print. Tell us what you think and comment on your colleagues’ views about EMN articles.

Latest Entry: 3/21/2023 AHEAD OF PRINT--BREAKING NEWS: A Catastrophic Match: Now What?

Alice S.Y. Lee, MD

Alice S.Y. Lee, MD, shares what she has learned as an emergency physician in a high-acuity, high-volume hospital over her 25-year career in Emergency Medicine News’ newest online feature. Join her each month for a screencast — a podcast coupled with slides — covering tangible emergency medicine skills such as hip reductions, following guidelines, and suturing as well as the intangible ones such as medical decision-making, collaborating with colleagues, and handling difficult patients and consultants. The tangible ones, she says, are teachable; the intangible ones less so, but they can be absorbed with practice.

Dr. Lee is an emergency physician in Phoenix, an assistant professor of emergency medicine at the University of Arizona College of Medicine in Phoenix, and a graduate of the Maricopa Medical Center emergency medicine residency. She said she was motivated to share her most interesting cases to impart, instruct, and inspire emergency physicians who are out there day after day, shift after shift, just doing their job. Those three Is give the screencast its name: iCubed. The screencast will impart knowledge to apply to everyday emergency medicine practice, instruct on the subtle and individual variations of compassionate bedside patient care, and most of all, inspire excellence in the practice of emergency medicine.

“I still love the medicine after all these years of practice. What we do really matters, but once we have finished our formal training, which is very organized and regimented, we are out in the real world,” Dr. Lee said. “The difference between academic and clinical emergency medicine can be quite confusing and frustrating. My hope is to demonstrate how in real practice one goes about giving the best patient care possible. I will do this by walking through a real case each month, discussing the thought process as we go through the case.”

It’s all about the starfish on the beach, Dr. Lee said. Don’t know that story? Read it here: https://starfishproject.com/the-parable/. In short, it’s about making a difference.

Find iCubed under the Videos navigation tab on www.em-news.com. You can also read Dr.Lee’s blog at https://azerdocmom.wordpress.com, follow her on Twitter at @azerdocmom, and read more about her in the MedPage Today feature, "10 Questions," at http://bit.ly/1S0gHG7.

Latest Entry: 10/28/2022 The Feeling of Drowning

Lisa Hoffman

Welcome to the Case Files!
The Case Files is an anecdotal collection of emergency medicine cases to enable physicians and researchers to find clinically important information on unusual conditions.

Case reports should focus on:

  • Unusual side effects or adverse interactions.
  • Unusual presentations of a disease.
  • Presentations of new and emerging diseases, including new street drugs.
  • Findings that shed new light on a disease or an adverse effect.

Comment on a case or submit your own case following the instructions in the Submissions box to the right.

Latest Entry: 10/16/2019 A Rare Case of Gastric Volvulus with Hiatal Hernia

Lisa Hoffman
This blog serves as a bulletin board for ED staff to share unusual and interesting photos of life in the ED.
It is also a partner with our Instagram account, @em_news, where you can find these photos on the go.
Have a clinical photo to share? Make sure it meets these criteria:
  • You must have taken the photo yourself. No “borrowing” from someone else or another website.
  • You must have written permission to submit someone else's photo. Send us the photographer’s name so we can give credit.
  • Sending a photo of a patient? You need his written permission to take it and to send it to us.
  • Be sure to obscure the patient’s face and identifying details even if you have permission (HIPAA, you know).
  • Send us the particulars about your photo: the patient’s symptoms, history, tests performed, therapies started, disposition, and outcome.
Send your entries to [email protected].

Latest Entry: 6/8/2023 Steer Clear of LPs for Diagnosing SAH

Rick Pescatore, DO

Welcome to What to D.O.
What to D.O., formerly known as Little White Coats, is the brainchild of Richard M. Pescatore II, DO, the director of emergency medicine research for the Crozer-Keystone Health System in Chester, PA.. He chronicled his experiences here as he completed his studies at the Philadelphia College of Osteopathic Medicine and in the emergency medicine residency at Cooper University Hospital in Camden, NJ.

Dr. Pescatore has served as an EMS and law enforcement medical director and advisor throughout New Jersey and Pennsylvania. He was graduated from the U.S. Naval Academy with a degree in aerospace engineering, and had planned to pursue a career as a nuclear submarine officer until an EMS run five years ago took him to a familiar but unexpected place. That call made him realize that EMS was more than a hobby and that his future was in medicine.

Read more about how Dr. Pescatore ended up as a "little white coat" in his first blog post, "Changing Course," and don't forget to sign up for the RSS feed for this blog to read his new entries.

Latest Entry: 8/15/2017 Proud to be an EP—Finally

Brady Pregerson, MD
This blog will cover a new ECG topic every month with emphasis on interesting tracings and lessons that will change or improve your practice of emergency medicine.

Latest Entry: 11/2/2020 Don't Let Substance Use Bias Lead to Anxiety or GERD Diagnosis until ACS is Ruled Out

Lisa Hoffman
Emergency Medicine News’ own survey delves into all the factors that affect the day-to-day practice of emergency physicians. We’ll look not just at salary, but at how the specialty breaks down by gender, age, years in practice, and much more.

Latest Entry: 1/16/2019 Happier EPs are Choosing to Stay Put

Gregory S. LaSala, MD; Rita G. McKeever, MD; and Jolene Yehl, MD
The Tox Cave will dissect interesting ED cases from the perspective of a toxicologist, focusing on applying up-to-date management of the poisoned patient. The name Tox Cave was coined by a former toxicology fellow to describe our small office space, likening it to the Bat Cave. The Tox Cave is where Drexel toxicology fellows and attendings have gathered to discuss the nuances of toxicology over the years.

Latest Entry: 8/2/2021 August 2021: Adulterant in Fentanyl Complicates OD

Michael Mouw, MD

Mistakes, near-misses, and bouncebacks. Chances are we mere mortals who have been at this a while have a case or three we aren't proud of. The trouble is that the medical culture doesn't exactly encourage admitting one's human errors, at least not outside M&M peer review.

This blog, moderated by Michael Mouw, MD, aims to provide a collegial forum for emergency physicians to share lessons they learned from mistakes made in the practice of emergency medicine.

Submit your case about errors you've learned from, and we will publish it here with a brief analysis by Dr. Mouw. All cases will be published anonymously, though you may choose to include your name, as Dr. Mouw has done with the first case.

Submit your case to [email protected].

A few rules:

  • Mind HIPAA! No names (patients or otherwise) or identifying characteristics.
  • Cases should not exceed 500 words, and will be edited for style, grammar, length, and clarity.
  • Photographs, clinical images, and lab reports are welcome, and should be submitted as separate attachments. Images should be 300 dpi and in jpg, tif, gif, or eps format.
  • Authors are responsible for obtaining consent from patients, family members, and health care professionals depicted in images, and must attest to EMN that consent was obtained.
  • Authors should submit their full name. This will not be published unless permission is granted.
  • Include all relevant information about the patient in the case as well as a full description of the patient's symptoms, diagnosis, treatment, and outcome.
  • Only post cases outside the statute of limitations. Please provide your retrospective insights and analysis, and any pertinent references you've found helpful.
  • Comments about the cases posted are also welcome. Be kind. Submit yours to [email protected]. Word limit: 200 words.
  • Submission grants permission to publish in EMN, its website, enews, and other formats.

Latest Entry: 8/2/2021 August 2021: A Temptation Resisted

Alberto Hazan, MD and Jordana Haber, MD
The husband-wife team of Alberto Hazan, MD, and Jordana Haber, MD, are interested in medical education, and will use this blog to reflect on the way emergency physicians practice.

Latest Entry: 8/11/2015 Should Medicine Have A Cosmological Constant?

James R. Roberts, MD & Martha Roberts, ACNP, PNP

Renowned emergency physician James R. Roberts, MD, and his daughter, Martha Roberts, ACNP, PNP, are teaming up to create a new EMN blog, The Procedural Pause.

The blog will focus on procedures that emergency medicine residents and midlevel providers are often called on to perform in the ED. Each case will cover the basics, the best approach for treatment, and pearls and pitfalls.

The Procedural Pause publishes anonymous case studies that required an ED procedure. The site welcomes all providers to share their ideas about emergency medicine, procedures, and experience with similar cases. Application of the information in this blog remains the professional responsibility of the practitioner.

Like all texts, manuals, support guides, and blogs, this site conveys personal opinions and experiences. Providers may approach a patient or procedure in many ways, and this blog is not a dictum nor is it meant to dictate standard of care. It is a clinical guide, not a legal document; do not reference this site in court or as a defense. It is your responsibility to follow your hospital’s procedures and protocol and to practice under the guidelines of your professional license.

Latest Entry: 11/30/2020 Digital Otoscope Enhances Decision-Making and Improves Outcomes