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Burn, baby, burn... on strep throat, insufficient anesthesia, and other woes
Disclaimer: This is not a real advertisement, it is not a real product,and Jackie Chan has not endorsed it. Yet.So, it happened that over the last Thanksgiving I was stricken for the first time with the dreaded strep throat. A miserable business. In addition to the antibiotics, the Doc gave me a prescription for a lidocaine rinse to ease what was a surprisingly incredible amount of pain for a sore throat. Turned out to be about as useful as a snooze button on a smoke detector. You can't swish and gargle the stuff because it's as viscous as honey, but you're not supposed to swallow it either (presumably because you don't wa...
Source: Across the Bilayer - January 12, 2014 Category: Medical Scientists Source Type: blogs

The Saga Continues: Posterior Shoulder Dislocation
We finish our shoulder dislocation series by paying our respects to posterior shoulder dislocation. Posterior shoulder dislocations are rare, and account for less than 4-5 percent of all shoulder dislocations, but all ED providers should know how to identify and relocate these injuries. Cases of misdiagnosis and even late diagnosis can occur. Early recognition and appropriate management can save a patient from complicated issues related to the dislocation as well as chronic pain. Anteroposterior (AP) view, left, of a patient with a posterior dislocation. This dislocation may be difficult to appreciate on an AP view becaus...
Source: The Procedural Pause - December 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

You MUST recognize this pattern, even if it is not common
Disclaimer: I never state from where I get a case. They come from all over the world. Any case may or may not be from my own institution. Do not make any assumptions.Case: A non-English speaking woman in her 60's with h/o HTN, type II DM, hyperlipidemia, CAD s/p CABG 16 years prior, and end stage renal disease on dialysis presented to the ED at time 0. She had awoken 7 hours prior with severe headache followed by upper chest heaviness and vomited x 2. EMS placed an 18 gauge IV, gave 2 NTG, and aspirin. She stated the pain was not similar to a previous MI. BP was 200 systoli...
Source: Dr. Smith's ECG Blog - November 22, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!). These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs

Yet Another Shoulder Dislocation
No series on dislocations would be complete without mentioning shoulder dislocation. Most shoulder dislocations (>90%) are anterior (forward), and it should be noted that shoulder dislocations make up about half of all dislocations seen in the ED. Most shoulders can be relocated easily, while others may frustrate a provider. Associated fractures, artery or nerve compromise, and even rotator cuff injuries can worsen the situation. Relocation techniques can be difficult, and may be physically challenging for the provider and patient. Acute shoulder dislocation with fracture of tuberosity. (Photo by James Roberts) T...
Source: The Procedural Pause - November 1, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Polymorphic Ventricular Tachycardia
A woman in her 40's presented with multiple "spells" in the past week, with increasing frequency. She feels lightheaded, then becomes unresponsive. It usually lasts about one minute then resolves. She has had no chest pain. She has a history of seizures as a child but there is no seizure activity during these spells.The monitor shows this:Ventricular Tachycardia, rate approximately 220 beats per minuteDuring this rhythm she was awake, protecting her airway, with pallor, diaphoresis and cool extremities. Pulses were present. There was no respiratory distress.A 12-lead ECG was recorde...
Source: Dr. Smith's ECG Blog - October 12, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Pediatric Nasal Foreign Bodies
Many of my pediatric patients with nasal foreign bodies present to the emergency department for chief complaints unrelated to the nose. The young man shown below, for example, presented several years ago for the evaluation of dog bite wounds to the face. I could see the telltale signs and symptoms of a chronic unilateral nasal drainage the minute I walked in the room. (Figure 1.) Figure 1. Nasal drainage is the telltale sign of a nasal foreign body. I questioned the patient and his father, and they offered no history to confirm insertion of a nasal foreign body. Nevertheless, a wad of mummified Halloween candy wrapping...
Source: M2E Too! Mellick's Multimedia EduBlog - September 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Here, Fishy, Fishy
The skilled ED provider always takes proper precautions before attempting fish bone removal and preparing for patient discharge. And a sensible provider never sends an anxious patient down river without a thorough exam. Fish bones are usually slightly waxy, bendable, and sharp. These tiny bones lodge themselves in the throat with a vengeance. Common nesting sites of fish bones include the base of the tongue, tonsils, posterior pharyngeal wall, aryepiglottic fold, or upper esophagus. Late complications of leftover fish bones in the throat may cause airway obstruction or rarely esophageal perforation. The patient is alway...
Source: The Procedural Pause - August 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Pain Predicament
A family doctor calls to give us a heads up about a patient coming to the emergency department. He was obviously upset and sounded frustrated. He started in with the story … I used some lidocaine a pair of tweezers, and some small scissors to remove a small lesion from a patient’s tongue. There was a little bleeding afterwards, but that seemed to stop with pressure. Then the patient said that it felt like her tongue was swelling. I thought it was from the lidocaine, so I kept her in the office and watched her for a half hour, then sent her home. They wanted some pain medication. She was allergic to codeine, so I presc...
Source: WhiteCoat's Call Room - July 31, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Thanks For Watching
Its been a rough few weeks. The stories keep piling up on my desk. This one keeps coming to mind, so I figured I’d try to post it from my phone.* An elderly patient came in by ambulance after tripping over a curb. She fell and hit her face, causing a nasal fracture and a periorbital contusion. But she was also having an increasing headache and she had proptosis. That’s a bad sign. We got the CT scan of her brain and it confirmed our fears. She had a retrobulbar hematoma, meaning that there was an expanding blood clot behind her eye which was pushing her eyeball outwards against the eyelid. Because the lids push...
Source: WhiteCoat's Call Room - July 20, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

The agony & the ecstasy of EBM in symptom management
So, I decided I might blog a little again. Probably the occasional Journal Club of the Cloud-type posts. Christian and fellow bloggers, thank you for all you do in keeping Pallimed thriving and relevant. So, Eduardo Bruera & colleagues at MD Anderson have published the results of their long-awaited follow-up trial to their 2006 double-blinded, placebo controlled trial suggesting that methylphenidate (MP) is no better than placebo for cancer-related fatigue (CRF). Original 2006 trial here New 2013 trial here Journal of Clinical Oncology editorial on the 2013 trial here (hat tip to this editorial for pointin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2013 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs

CDM talk on updates in the diagnosis and management of ED arthritis
Welcome, readers from Clinical Decision Making. You've got a PowerPoint version of my talk on your USB drives; here's the link to today's Prezi.I frequently mentioned Chris Carpenter's excellent 2011 systematic review of ED septic arthritis; Margaretten's Systematic Review for JAMA is also worth a look.Other references from my talk:EPMonthly and EMPractice (new Rosen's chapter is not yet published)Terkeltaub's trial that changed colchicine regimens for goutKesselheim and Solomon in NEJM 2010 on the Curious Case of ColchicinePiper on the risks of local anesthetics on cartilageFitch 2008 on IA l...
Source: Blogborygmi - June 21, 2013 Category: Emergency Medicine Doctors Authors: Nick Genes Source Type: blogs

Feel the Felon
Last time we discussed some ways to approach and manage the acute paronychia, but yet another unfortunate criminal robs our nail of its fine fettle: the nefarious felon. The felon’s early signs and symptoms may be subtle so don’t be fooled. This tender, fingerpad infection is not to be ignored. The enclosed fascial spaces of the fingertip pulp will be tender, and appear red and hot, which should mimic your aggressiveness and approach to stop it in its tracks. Figure out that felon, be tender, and forge ahead! Some thoughts before proceeding. Your fingertip has thousands of nerves, and is very sensitive. Consider all...
Source: The Procedural Pause - May 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The LITFL Review 103
Welcome to the 103rd edition! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. The Most Fair Dinkum Ripper Beaut of the Week The Sono Cave For those of you that love ultrasound or just learning – The Sono Cave is the ultimate EM blog fo...
Source: Life in the Fast Lane - May 7, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs