Administrative Fellow Emory University, Department of Emergency Medicine Attending Physician
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 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 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 …
Jul 28
Presentation: 48 to M accidentally injected Epipen into finger Physical Exam: Pale painful finger with decreased sensation. Management: Nitroglycerin ointment to finger and 1.5mg Phentolamine mixed with 1cc 2% lidocaine and inject into the finger. Outcome: Patient was discharged with close hand followup.
Jul 26
Case: 5 yo F with sudden onset of R sided neck pain, no PMHx Presentation: VS NL, no report of trauma, well appearing child crying, head twisted with chin pointing toward L shoulder Diagnosis: Torticollis. Spasm of the sternocleidmastoid common in children. On the differential is retropharyngeal abscess in patients with sore throat and fever …
Jul 14
Radiation Risk: Average US background radiation in one year: 3 mSv CxR: 0.02 mSv Pelvis XR: 0.7 mSv CT Head: 2mSv CT Chest: 8mSv CT A/P: 10mSv Cardiac PET: 14mSv So what is the risk for cancer? It varies by study type, age, and sex. So for example, if a 20 yo F gets a …
Jul 13
Ear Lacerations: Pt. with a laceration through the helix of the ear with exposed cartilage 2 Point Ear Block: Am Fam Physician. 2004 Feb 1;69(3):585-590. Goal: Approximate cartilage with absorbable 5-0 monocryl. It’s ok to trim away small amount of jagged or devitalized skin or cartilage to ensure proper approximation. Close the skin over the cartilage with 5 …
Jul 11
Exciting topic: Anal Fissures! Definition: Tear in the anorectal dermal tissue, usually at the posterior “6 o’clock” position where the anorectal muscle come together Hx: Patient presents with sudden onset rectal pain with small amount of bleeding PE: Usually posterior tears, but if tear occurs at any other position consider comorbid conditions such as IBD …
Jul 09
Got a hypertensive pregnant patient? Preelampsia: Hypertension >140/90 with proteinuria >300mg/24hours Eclampsia: Addition of SZ activitity, signs of end organ involvement (i.e. visual complaints and headache, creatinine elevation) Watch out for HELLP! Hemolysis, elevated liver enzyme, low platelets Treatment: Expectant management, delivery if possible, treat seizures with Magnesium Dose: 6g loading followed by 2g/hour Learning point …
Jun 26
This case Courtesy of David Zhou and Patrick Meloy: EMory Files Case #7: Deltoid Abscess Hx: 37 yo female with a hx of IV heroin abuse (IVDA) who presents with bilateral shoulder pain. She has been injecting heroin using the skin popping method PE: Temp: 37.3 °C, Heart Rate: 60, RR: 17, BP: 122/58 …