A Nefarious Character with an Agenda

Every new advanced nurse practitioner, physician assistant, or resident gets his fair share of complex emergency department procedures during training. Seasoned providers, however, are just as excited to place a central line in a septic patient, LP a "rule-out meningitis," or swiftly fix a nursemaid's elbow.This month we hope to remind you of a few sweet and satisfying procedures that take only moments to do. Your skill in completing these procedures is imperative. Not only will you amaze your patient, but you'll shorten your door to dispo-time.The StyeThe stye is a nefarious character with an agenda. It starts off by slowly enlarging over the patient's lid, and it can consume other portions of the face if not treated appropriately. Patients may present to the ED on the fifth day or later when the enlarged lid starts to impair their vision. Occasionally, patients have associated facial swelling, tenderness, or even a preseptal cellulitis. Distinguishing the signs of these complications is imperative for proper treatment. It may be difficult to discern the emergent eye from the urgent eye from the "it-can-wait" eye. You will feel confident about draining an eye lid abscess after reading this post, and you can add one more magic ace to your deck. The ApproachIdentification of stye (or hordeolum)Evert the lid to look for the pus collectionIf pus is readily seen, incision and drainage of styeCorrect outpatient treatments and aidesOphthalmology follow-upTh...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
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Source: Brain Stimulation - Category: Neurology Source Type: research
ConclusionThe twin block is effective in the long-term management of masticatory myofascial pain as compared to trigger point injections.Trial RegistrationClinicalTrials.gov Identifier: NCT03870191
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ConclusionNeedle flexor tenotomies are a relatively safe and effective treatment compared to tenotomies done by scalpel, both as treatment for ulcers and to prevent formation of new ulcers associated with hammer, mallet and claw toe deformities. As a side note, transfer complications are avoidable if all toes on one or both feet are tenotomized in one procedure.
Source: Journal of Clinical and Translational Endocrinology - Category: Endocrinology Source Type: research
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Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (rem...
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
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Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
ConclusionsThis case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients.ResumoJustificativa e objetivosA ressonância magnética (RM) cardíaca é uma técnica utilizada na avaliação de crianças com cardiopatias congênitas. A anestesia geral garante imobilidade, especialmente em pacientes não cooperador...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
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