Oct 24
Clinical Question: What would you do if you have a patient with cellulitis, but you are still worried about an underlying septic joint?? Clinical Vignette: 47 yo M with L knee pain, swelling, redness and immobile. PE: Fever, tachycardia, and a swollen L knee Phys Ex: Clinically cannot move the joint Source Staph is most …
Sep 19
If in extremis: Symptoms: Seizures, AMS, brain herniation, cerebral edema Treatment: 100cc 3% hypertonic saline over 20 minutes – reevaluate and repeat x 3 if necessary until neurologic signs are gone How to evaluate Hyponatremia: 1st step – Determine which of the 3 kinds it is by calculating the serum Osms. Hypertonic – (serum …
Sep 18
Lau JY et al. 2007. Omeprazole before endoscopy in patients with gastrointestinal bleeding. NEJM. 356:1631-40. Take home points: 638 patients with upper GI bleed undergoing endoscopy were randomized to receive omeprazole vs placebo. The patients who received omeprazole prior to endoscopy had less need for intervention during endoscopy, fewer actively bleeding ulcers. A higher percentage …
Sep 12
Case Presentation: Hx: 57 yo M p/w fall from 10 feet complaining of L ankle pain PE: Primary survey intact. Secondary survey for apparent intoxication and ankle deformity. EFAST negative. CxR, Pelvis XR and PAN Scan negative. Ankle Fractures Learning Points: 1) Anatomy: The ankle joint is made up of the medial malleolus (distal tibia), …
Aug 29
Coll, Deirdre M, Michael J Varanelli, and Robert C Smith. “Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT.” American Journal Of Roentgenology 178.1 (2002) : 1644. Take Home Points: Spontaneous passage rate of ureteral calculi varies depending on size and location Size: 87% of stones 1mm in …
Aug 21
Anna Yaffee Recent articles 52 in 52: Nobay et al. 2004. A prospective, double-blind, randomized trial of midazolam vs haloperidol vs lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med. 11(7): 744-749. Take home point: In this double-blind, randomized trial of 111 violent and severely agitated patients in a county …
Aug 18
Presentation: 37 yo F with progressive headache, R hand tingling, and incidentally found on this ER visit to be pregnant. Top 5 Teaching Points Cerebral Vein Thrombosis (1): 1) It’s rare: about 1:100,000 in a year (but about 11:100,000 in pregnant women) 2) Pt’s present with a progressively worsening localizing headache over days (as venous …
Aug 13
In preparation for airway simulation lab, we read: Reed MJ, Dunn MJG, McKeown DW. 2005. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J. 22(2):99-102. Take home points: LEMON criteria: (L- Look externally for characteristics known to cause difficulty; E- Evaluate the 3-3-2 rule; M- Mallampati; O- Obstruction; …
Aug 04
Aortic Dissection is one of those diagnoses that gets everyone’s heart rates up (despite beta blockers), and its something we (should) think about in all of our blunt trauma patients. The proximal descending aorta is the great vessel most susceptible injury in blunt trauma, due to its relative mobility over the fixed abdominal aorta, which …
Aug 01
Presentation: 46 yo M with 2 day hx of RUQ pain and n/v. Taking Tylenol for pain. PE: VS NL, appears distressed, + TTP in RUQ and epigastrium Workup: RUQ US: showing sludge in gall bladder, no stones, no pericholecystic fluid and the wall was not thickened. However, the common bile duct was dilated to 8mm …