Category: Orthopedics
Keywords: Clavicle, fracture, surgery (PubMed Search)
Posted: 5/25/2008 by Michael Bond, MD
(Updated: 2/15/2025)
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I remember being taught as a medical student that clavicle fractures could be treated conservatively. A direct quote was "if both ends of the clavicle are in the same room it will heal".
Though conservative treatment with a sling for 6 weeks with early pendulum ROM exercises for the shoulder is appropriate for the vast majority of clavicle fractures surgery should be considered for those that have:
Category: Pediatrics
Keywords: ALTE, Menningitis, Sepsis (PubMed Search)
Posted: 5/24/2008 by Don Van Wie, DO
(Updated: 2/15/2025)
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ALTE and Infections - when to do full septic workups?
Given some recent cases of newborns with ALTEs at UMMS and Wash Co I thought I'd offer the following Pearls:
That being said THE RISK OF MISSING A SERIOUS LIFE THREATENING INFECTION is much greater than the risk of doing a complete septic workup, administering antibiotics, and admitting an infant with an ALTE.
McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004;89(11):1043-8.
Category: Toxicology
Keywords: chlorine, pneumonitis (PubMed Search)
Posted: 5/22/2008 by Fermin Barrueto
(Updated: 2/15/2025)
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Pool Cleaner Toxicity - Chlorine Gas Exposure
The "shock" treatment that is utilized in pool cleaner is often contained in a large plastic container and is calcium hypochlorite. Chlorine gas accumulates in the small amount of airspace found in the container. If a future patient opens the container either in an enclosed space or within close proximity of the face that allows for large inhalational exposure.
Category: Neurology
Keywords: traumatic brian injury, TBI, respirations, cheyne-stokes, hyperventilation (PubMed Search)
Posted: 5/22/2008 by Aisha Liferidge, MD
(Updated: 2/15/2025)
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Category: Misc
Keywords: superior vena cava, svc syndrome (PubMed Search)
Posted: 5/20/2008 by Rob Rogers, MD
(Updated: 2/15/2025)
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Superior Vana Cava Synrome....when to suspect
Two common causes of SVC syndrome include thrombus (secondary to CV catheters) and lung tumors/lymphoma
Consider this diagnosis in patients with a history of cancer and/or who have a central line in place and the complaint of facial swelling. Patients may not look swollen to you.
In addition, make sure to look at their necks and chest wall-presence of asymmetric, prominent veins should prompt consideration for this diagnosis.
A useful clinical tool is to look at the patient's driver's license (assuming they have one) and compare to their appearance on presentation.
Workup in most cases will involve a CT of the chest.
Clinical Oncology, 2007
Category: Critical Care
Keywords: bicarbonate, pH, COPD, mechanical ventilation (PubMed Search)
Posted: 5/20/2008 by Mike Winters, MBA, MD
(Updated: 2/15/2025)
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COPD and mechanical ventilation
Ward NS, Dushay KM. Clinical concise review: Mechanical ventilation of patients with chronic obstructive pulmonary disease. Crit Care Med 2008;36:1614-9.
Category: Orthopedics
Keywords: Mallet finger, Extensor Injury (PubMed Search)
Posted: 5/18/2008 by Michael Bond, MD
(Updated: 2/15/2025)
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Extensor Tendon Injuries [Mallet Finger]
Category: Cardiology
Keywords: electrocardiography, ECG, STEMI, acute myocardial infarction, rescue PCI (PubMed Search)
Posted: 5/18/2008 by Amal Mattu, MD
(Updated: 2/15/2025)
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According to the most recent (2007 Updated) ACC/AHA Guidelines for management of STEMI, the ECG is one of the most important tools to assess for successful reperfusion after thrombolytics. The treating physician should assess the ECG at 90 minutes after administration of lytics. Failure of the ST elevation to decrease by at least 50% in magnitude in the lead with the greatest initial amount of ST elevation is an indication of failed thrombolysis...regardless of whether or not the patient has persistent symptoms. In fact, the Guidelines specifically state that signs and symptoms are considered unreliable indicators of successful reperfusion.
Patients with ECG evidence of failed thrombolysis at 90 minutes should be referred for emergent PCI ("rescue PCI").
Category: Pediatrics
Keywords: Retropharyngeal Abscess, Neck Pain, Torticollis, Fever (PubMed Search)
Posted: 5/16/2008 by Sean Fox, MD
(Updated: 2/15/2025)
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Retropharyngeal Abscess
Craig, FW and Schunk, JE. Retropharyngeal Abscess in Children: Clinical Presentation, Utility of Imaging, and Current Management. Pediatrics. 2003;111;1394-1398
Category: Toxicology
Keywords: cyanide (PubMed Search)
Posted: 5/15/2008 by Fermin Barrueto
(Updated: 2/15/2025)
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Toxicology Trivia for $1000 - These are in fruits of the "rose" family and in some roots that contain cyanogenic glycosides and other cyanide containing compounds. It would actually take a fair amount of work to ingest enough to reach toxicity:
Category: Neurology
Keywords: orbital floor fracture, neuropathy (PubMed Search)
Posted: 5/14/2008 by Aisha Liferidge, MD
(Updated: 2/15/2025)
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-- Enophthalmos (eye receded into the orbit) may occur when globe is
displaced posteriorly, often with prolapse of tissue into maxillary sinus.
-- Orbital dystopia (affected eye in a lower horizontal plane than the other) may
occur due to the pulling of entrapped muscle and orbital fat.
Category: Critical Care
Keywords: PEEP, acute lung injury, acute respiratory distress syndrome (PubMed Search)
Posted: 5/13/2008 by Mike Winters, MBA, MD
(Updated: 2/15/2025)
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Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)
Category: Vascular
Keywords: AV Fistula (PubMed Search)
Posted: 5/13/2008 by Rob Rogers, MD
(Updated: 2/15/2025)
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Management of Ruptured AV Fistula
This pearl pertains to a case I had 2 weeks ago. A 65 yo male presented with a massively swollen left forearm in the region of his AV fistula. On ultrasound he had a 6 X 6 cm aneurysm. He was seen by vascular and transplant surgery and taken to the OR for repair.
So, the question came up, what would an emergency physician do if this bad boy actually ruptured? Well, obviously we would hold pressure. But what if that didn't work? Well, shouldn't the patient go to the OR? The answer is a resounding yes, but what if there is no surgeon around. There is not much literature on how to handle this devastating vascular catastrophe.
As a rule of thumb, if an AV Fistula ruptures (not leaks) and the patient is exsanguinating in front of you:
J Vasc Surg 2005
Category: Cardiology
Keywords: Brugada syndrome, atrial fibrillation (PubMed Search)
Posted: 5/11/2008 by Amal Mattu, MD
(Updated: 2/15/2025)
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Brugada syndrome, believed to be responsible for up to 4-5% of all episodes of cardiac arrest, has now been associated with atrial fibrillation as well (atrial fibrillation is the most common atrial dysrhythmia associated with Brugada syndrome). Patients with atrial fibrillation that have a full or incomplete right bundle branch block with ST segment elevation in leads V1-V2 should be referred to an electrophysiologist for evaluation of Brugada syndrome. The best treatment for these patients is still placement of an ICD.
Category: Orthopedics
Keywords: Posterior Interosseous Nerve, Compression, Radial Tunnel (PubMed Search)
Posted: 5/11/2008 by Michael Bond, MD
(Updated: 2/15/2025)
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Posterior Interosseous Nerve Compression Syndrome
As eluded to last week Posterior Interosseous Nerve (PIN) Compression Syndrome, a deep branch of the radial nerve, is felt to be radial tunnel syndrome with paralysis.
Category: Pediatrics
Keywords: Acute Otitis Media, Topical Lidocaine, Wait and See, Analagesia (PubMed Search)
Posted: 5/9/2008 by Sean Fox, MD
(Updated: 2/15/2025)
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Topical Lidocaine for Acute Otitis Media
Spiro, D. Tay, K. Wait-to-see prescription for the treatment of acute otitis media. JAMA 2006, 1235.
Bolt, P., Barnett, P., Babl, F., Sharwood, L. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008; 93: 40-44.
Category: Toxicology
Posted: 5/8/2008 by Fermin Barrueto
(Updated: 2/15/2025)
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Bass. Sudden Sniffing Death. JAMA 1970.
Category: Neurology
Keywords: TIA, Stroke (PubMed Search)
Posted: 5/8/2008 by Aisha Liferidge, MD
(Updated: 2/15/2025)
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Category: Critical Care
Keywords: propofol (PubMed Search)
Posted: 5/7/2008 by Mike Winters, MBA, MD
(Updated: 2/15/2025)
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Propofol Infusion Syndrome
Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia 2007;62:690-701.
Category: Vascular
Keywords: Hypertension (PubMed Search)
Posted: 5/6/2008 by Rob Rogers, MD
(Updated: 2/15/2025)
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Side Effects of Hydrochlorothiazide
Consider the following when prescribing HCTZ from the emergency department:
The side effects of hydrochlorothiazide include hypokalemia,hypercalcemia, hypomagnesemia, metabolic alkalosis, hyponatremia, hyperuricemia (may worsen gout), hyperglycemia, hypercholesterolemia, hypertriglyceridemia.
Journal of Hypertension, 2006