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Clinical Scenario A 68-year-old man presents with right-sided weakness and slurred speech (NIHSS 12), with a negative CT, making him a clear thrombolytic candidate. As you review the risks and benefits, she seems to be on board, but asks, “What’s his chance of bleeding? Do you think it’s worth it?” You step out briefly, pull up MDCalc to better individualize the risk. Check out the HAT and SEDAN scores on MDCalc to quickly assess post-tPA hemorrhage risk at the bedside. Summa

Clinical Scenario A patient arrives after a high-speed MVC with obvious head trauma. He is confused, intermittently combative, and requires rapid sedation for imaging. Upon his return from CT, the team attempts to calculate a GCS, but sedation, and deteriorating neurologic status make the score difficult to interpret. The question arises: is there a better way to quantify neurologic status at this moment? Summary Glasgow Coma Scale (GCS): Still the standard, but loses accurac

Clinical Scenario Seventy-five-year-old “Nana Eleanor” took her granddaughter ice skating for a birthday outing. Determined to prove she was still spry, she waved away the kiddie support walker—she’d “been skating since Nixon.” Mid-glide selfie attempt → sideways drift → slip on melted ice → hard impact against the boards. EMS found her seated upright, mildly breathless but joking, “Next time I’ll stick to shuffleboard.” In the ED, vitals showed RR 25, SpO₂ 94% on room air, n

Clinical Scenario Earl, proudly hosting his 75th birthday party, blew out the candles with such force (and cough) that half the frosting—and likely half the room—were coated in suspicious aerosols. Two days later, he arrived in the ED febrile and confused, with a respiratory rate of 32, SpO₂ 88% on room air, and systolic BP hovering around 90 mmHg. Chest X-ray showed multilobar infiltrates, and his heart rate was 115, raising concern for significant pneumonia severity. His fa

Clinical Scenario A 55-year-old man with a history of alcohol use disorder, gallstones, and hypertension arrives in the ED clutching his abdomen, describing pain that shoots straight through to his back. He’s nauseated, he’s vomited twice, and between groans, he mentions taking a thiazide diuretic - and possibly being bitten by his pet scorpion (because, of course he has one). His mental status is normal, heart rate 110, other vitals unremarkable. Lipase? 2,500. So now the qu

Clinical Scenario A 6-month-old rolls off the couch, bumps his head, and immediately lets everyone know with a loud cry. Now he's back to his usual self—smiling, feeding like a champ, and trying to chew on your stethoscope. The only catch: a large, ominous-looking temporal hematoma that makes his parents' hearts race. They turn to you: "Doc, does our baby need a CT scan?" PECARN has been THE decision rule for guidance on management of kids with head injuries, but the Infant S

Clinical Scenario A 46-year-old man with hypertension and a fondness for double espressos and triple IPAs faints during his niece’s graduation in a sweltering gym. He has a quick recovery, is drenched in sweat,, and no seizure activity was witnessed. Was it the beverages and boring speeches - or something more concerning? The San Francisco Syncope Rule offers a quick screen for short-term risk, while the Canadian Syncope Risk Score adds nuance and clinical context for a more

Clinical Scenario A 35 year old woman with no past medical history presents to the ED with pleuritic chest pain and shortness of breath. She is tachypenic but has a normal heart rate and oxygen saturation. She denies leg pain or swelling, or h/o DVT/PE.. She uses oral contraceptives. Her EKG is normal. Cardiac, lung, and extremity exam are unremarkable. You are considering using the Wells' Criteria and/or PERC Rule. Where do you start? Summary Use Wells' first if you're unsur

Clinical Scenario A 55 year old woman with a history of hypertension and diabetes presents with chest pain for two hours. She describes it as a dull, burning and pressure-like pain in the middle of her chest that does not radiate. She denies any associated symptoms. She is well-appearing with a normal cardiac, pulmonary, abdominal, extremity, and neurologic exam. Her EKG is normal sinus rhythm without ischemic changes. After receiving Aspirin, Pepcid and Maalox, she states, “

Clinical Scenario A 45 year old man presents with neck pain after being rear-ended at 30 MPH. He was a restrained driver, airbags deployed, and he walked at the scene. He denies head injury, focal weakness, or paresthesias, and reports having one beer an hour ago. Exam: GCS 15, mild midline tenderness at C6–C7, full strength, non-focal neurological exam including normal speech and decision-making capacity, no other injuries. He asks, “Do I really need a CT Scan?” Summary CCR