Category: Orthopedics
Keywords: jones fracture,foot fracture,malunion (PubMed Search)
Posted: 6/21/2009 by Dan Lemkin, MS, MD
(Updated: 7/18/2009)
Click here to contact Dan Lemkin, MS, MD
Jones fracture
Presented with persistant foot pain from
Jones fracture malunion.
http://www.wheelessonline.com/ortho/jones_fracture
http://www.wheelessonline.com/ortho/avulsion_frx_of_base_of_5th_metatarsal
Category: Pediatrics
Posted: 7/17/2009 by Rose Chasm, MD
(Updated: 2/17/2025)
Click here to contact Rose Chasm, MD
Baskin MN. Injury-knee. In:Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:339-347
Staheli LT. Hip. In: Fundamentals of Pediatric Ortopoedics. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998:68-71.
Category: Neurology
Keywords: dysarthria, apraxia, lacunar infarcts, pure dysarthria (PubMed Search)
Posted: 7/15/2009 by Aisha Liferidge, MD
(Updated: 2/17/2025)
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Category: Critical Care
Posted: 7/14/2009 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
Click here to contact Mike Winters, MBA, MD
Lorazepam Infusions
Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin 2009;25:431-49.
Category: Misc
Keywords: Bradycardia (PubMed Search)
Posted: 7/13/2009 by Rob Rogers, MD
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Great case of bradycardia today in the ED-requiring transvenous pacemaker....cause?? K 7.6
Some bradycardia pearls:
Category: Cardiology
Keywords: pericarditis (PubMed Search)
Posted: 7/12/2009 by Amal Mattu, MD
(Updated: 2/17/2025)
Click here to contact Amal Mattu, MD
A recent study from Mayo evaluated 238 patients with acute pericarditis and found that the "classic" features of acute pericarditis that we learned about are actually not as common as we think:
1. Only 50% of patients reported that their pain was positional and 70% reported that their pain was pleuritic. On the other hand, 12% reported pain that was typical anginal in nature.
2. Only 35-45% of patients reported a recent history of a viral illness.
3. Only 15-25% of patients had a friction rub.
4. Further complicating matters was the presence of positive troponin levels in 13% of the patients.
In this study, 17% of patients were sent for PCI because the treating physicians diagnosed the patients as having an acute MI. This study highlights the importance of maintaining pericarditis in the DDx of any patients with chest pain, even when it "sounds like an MI," and also maintaining vigilance for atypical features of pericarditis.
Category: Procedures
Keywords: Lidocaine, Foley, NG tube (PubMed Search)
Posted: 7/11/2009 by Michael Bond, MD
(Updated: 2/17/2025)
Click here to contact Michael Bond, MD
NG Tubes and Foleys:
Dovetailing off Dr. Hayes Lidocaine pearl on Thursday I thought we could provide an additional pearl on how to decrease pain with the insertion of Foleys and NG tubes.
Most providers use regular surgilube and coat the tip of the NG tube and foley with it prior to inserting it. Unfortunately this tends to only lubricate the first several centimeters of the passage you are trying to transverse, making the rest of the way a little uncomfortable.
Using a Uroget of viscious lidocaine allows you to actually inject the lubricant into the nares or urethral meatus. This will provide better lubrication of the entire passage and also provide some anesthesia.
Even if you do not want to use lidocaine most foley kits come with a syringe full of surgilube that can be injected into the urethral meatus helping to lubricate the passage.
Category: Toxicology
Keywords: lidocaine, nebulized (PubMed Search)
Posted: 7/9/2009 by Bryan Hayes, PharmD
(Updated: 2/17/2025)
Click here to contact Bryan Hayes, PharmD
One of the options in our armamentarium prior to inserting an NG tube or performing a non-emergent nasotracheal intubation is nebulized lidocaine. However, the total dose is always a concern with this anesthetic agent before we have to worry about toxicity such as lightheadedness, tremors, hallucinations, seizures, and cardiac arrest. Here are some points to remember:
Category: Neurology
Keywords: cranial nerve I, olfactory nerve, hyposmia, anosmia, head injury, head trauma (PubMed Search)
Posted: 7/8/2009 by Aisha Liferidge, MD
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Category: Critical Care
Posted: 7/7/2009 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
Click here to contact Mike Winters, MBA, MD
The Cuff Leak Test
Ochoa ME, et al. Cuff leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med 2009;35(7):1171-9.
Category: Vascular
Keywords: Hypertensive, Encephalopathy (PubMed Search)
Posted: 7/6/2009 by Rob Rogers, MD
(Updated: 2/17/2025)
Click here to contact Rob Rogers, MD
Hypertensive Encephalopathy
Hypertensive encephalopathy (HE) is one of the true hypertensive emergencies. Although usually seen with diastolic BPs greater than 120 mm Hg, it can occur in patients with lower numbers. And the diagnosis can be really tricky to make. Sometimes the diagnosis isn't clear until symptoms resolve from BP reduction .
The presentation is variable and includes:
The goal of treatment is to reduce the BP NO MORE THAN 25% (of the MAP) within the first few hours. In addition, drugs like Hydralazine (which may lead to a precipitous decline in BP) and Clonidine (which can alter mental status) should be avoided.
Medications to consider for treating HE include intravenous drips-Fenoldopam, Nicardipine, Labetalol. Drugs like Nipride are probably best avoided since cyanide toxicity may alter a patient's mental status further.
Category: Pediatrics
Posted: 7/5/2009 by Rose Chasm, MD
(Updated: 2/17/2025)
Click here to contact Rose Chasm, MD
Davidson M, Wasserman R. The irritable colon of childhood (chronic nonspecific diarrhea syndrome). J Pediatr. 1996;69:1027-1038
Kneepkens CM, Hoekstra JH. Chronic nonspecific diarrhea of childhood: pathophysiology and management. Pediatr Clin North Am. 1996;43:375-390
Category: Orthopedics
Keywords: Blast, hand, injuries (PubMed Search)
Posted: 7/5/2009 by Michael Bond, MD
Click here to contact Michael Bond, MD
Blast Injuries:
In honor of the 4th of July holiday, here is a quick pearl about blast injuries.
Philipson MR, Southern SJ. The blast component of firework injuries--not to be underestimated. Injury. 2004:35; 1042-1043.
Category: Toxicology
Keywords: barbiturates, meprobamate, bromides, propofol (PubMed Search)
Posted: 7/2/2009 by Fermin Barrueto
(Updated: 2/17/2025)
Click here to contact Fermin Barrueto
The followings is a list of unique clinical findings related to a certain sedative-hypnotic overdose:
1) Hypothermia:Barbiturates, bromides, ethchlorvynol (others but these more pronounced)
2) Unique odors: chloral hydrate, ethchlorvynol (which is Placidyl)
3) Bradycardia: GHB (again others but pronounced in this OD)
4) Tachydysrhythmias: chloral hydrate
5) Muscular twitching: GHB, methaqualone, etomidate
6) Discolored urine: propofol (green/pink)
Adapted from Goldfrank's Toxicologic Emergencies 8th Edition, p1102.
Category: Neurology
Keywords: xanthochromia, csf, lumbar puncture, meningitis, subarachnoid hemorrhage, intracranial bleed (PubMed Search)
Posted: 7/2/2009 by Aisha Liferidge, MD
(Updated: 2/17/2025)
Click here to contact Aisha Liferidge, MD
Category: Critical Care
Posted: 6/30/2009 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
Click here to contact Mike Winters, MBA, MD
Coagulopathy from Acute Liver Failure
Trotter JF. Practical management of acute liver failure in the intensive care unit. Curr Opin Crit Care 2009;15:163-7.
Category: Medical Education
Keywords: Teaching (PubMed Search)
Posted: 6/29/2009 by Rob Rogers, MD
(Updated: 2/17/2025)
Click here to contact Rob Rogers, MD
Todays pearl pertains to a great new blog put together by Dr. Michelle Lin, entitled "Academic Life in Emergency Medicine." The blog is superb and is a great resource for anyone interested in academic EM.
Today's posting is about teaching when time is limited and Michelle discusses a really good article written by Irby, et al. This article addresses a topic that is very pertinent to us in the ED, how to teach when it is busy. Isn't it always busy?
Tips from the article:
1. Identify the learner needs (can't be successful without this important step)
2. Teach rapidly (great tips for how to do this in the ED)
3. Provide feedback (students are starving for this)
Want more??? Gotta check out the article....
Here is the link to the site:
http://AcademicLifeinEM.blogspot.com/
Enjoy!
Category: Cardiology
Keywords: pericarditis (PubMed Search)
Posted: 6/28/2009 by Amal Mattu, MD
(Updated: 2/17/2025)
Click here to contact Amal Mattu, MD
Pericarditis is one of the conditions that is often misdiagnosed as STEMI, resulting in "inappropriate" cath lab interventions. In addition to producing STE, pericarditis also may produce dyspnea, diaphoresis, and elevations in TN levels, all of which will mimic true ACS.
On the other hand, pericarditis does NOT produce STE in up to one-third of cases, so the diagnosis may be missed. Non-STE cases of pericarditis occur more often in women, in patients with pericardial effusions, and in patients without preceding viral syndromes.
[Salisbury AC, et al. Frequency and predictors of urgent coronary angiography in patients with acute pericarditis. Mayo Clin Proc 2009;84:11-15.]
Category: Orthopedics
Keywords: Metacarpal, Fracture, Growth, Plate (PubMed Search)
Posted: 6/28/2009 by Michael Bond, MD
(Updated: 2/17/2025)
Click here to contact Michael Bond, MD
Metacarpal Fractures and Growth Plates:
The growth plates on metacarpals are on the distal end of the bone, except for the 1st metacarpal which is on the proximal end near the carpal bones.
Don't mistake this for a fracture line, however, make sure you get comparison views if they are tender over the area, as this can help you diagnosis a Salter Harris Type 1 fracture.
Category: Pediatrics
Keywords: Noninvasive, Ventilation, Pediatrics (PubMed Search)
Posted: 6/27/2009 by Don Van Wie, DO
(Updated: 2/17/2025)
Click here to contact Don Van Wie, DO
Noninvasive ventilation use in children has been shown in some trials to be a useful tool to avoid intubation in children with asthma.
Since children with asthma who are intubated have a much higher risk for complications including pneumotharaces and pneumomediastinum this can be a very useful tool.
Bi-Pap is usually started with typical settings of 10 for IPAP and 5 for EPAP and can be titrated up as tolerated to levels of up to 25/20 cm H2O and can be delivered with a set rate or a back up rate.
Albuterol and nebulized epiephrine may be delivered through newer BiPAP machines.
Signs that BiPAP is working include decreased Respiratory Rate, decreased retractions and accesory muscle use, improved oxygenation saturation
Noninvasive Ventilation Techniques In The Emergency Department:Applications In Pediatric Patients. Pediatric Emergency Medicine Practice June 2009. Vol 6, No 6