Tenosynovitis: Two-Touch Diagnosis
Today you are the fast-track provider, and you are on the hunt for procedures. You notice a 35-year-old woman signing into triage with a chief complaint of wrist pain.
This patient looks otherwise healthy, is pushing a stroller with her right hand, and is carrying a second child on her left. What’s the emergency? There isn’t one, but it is an emergency to this patient because she cannot push that stroller another day! If she cannot push the stroller, then she cannot get the kids to day care. And, if she cannot get the kids to day care, then she cannot go to work. Ask anyone with children, it is an emergency.
...
Source: The Procedural Pause - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Tenosynovitis: Two-Touch Diagnosis
Today you are the fast-track provider, and you are on the hunt for procedures. You notice a 35-year-old woman signing into triage with a chief complaint of wrist pain.
This patient looks otherwise healthy, is pushing a stroller with her right hand, and is carrying a second child on her left. What’s the emergency? There isn’t one, but it is an emergency to this patient because she cannot push that stroller another day! If she cannot push the stroller, then she cannot get the kids to day care. And, if she cannot get the kids to day care, then she cannot go to work. Ask anyone with children, it is an emergency.
This...
Source: The Procedural Pause - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 179
Welcome to the 179th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the Week If you do one FOAM-centred thing this week, spend 5 minutes watching this video on patient-centred care. Thanks to the International Forum on Quality and Safety In Healthcare 2015 [SO] The Best of #FOAMed Emergency MedicineKen Milne and Salim R...
Source: Life in the Fast Lane - April 26, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs
LITFL Review 177
Welcome to the 177th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the WeekMichelle Johnston manages to capture, in her superbly eloquent style, the heartbreak of the Wrong type of Swiss Cheese. Errors must be prevented, yes. But not at the cost of our humanity. [SO] The Best of #FOAMed Emergency MedicineThe April issu...
Source: Life in the Fast Lane - April 12, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying ho...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Patch Down the Hatch
A 42-year-old man presented with somnolence. His initial vital signs were heart rate 54 bpm, blood pressure 92/68 mm Hg, temperature 37°C, respiratory rate 6, and pulse oximetry 90% on room air. His physical examination was remarkable for depressed level of consciousness, miosis, and bradypnea. His mental status and respiratory rate temporarily improved with the administration of 0.04 mg naloxone. He reports swallowing several “patches” in a suicide attempt.
Popular transdermal patches are listed in the table. Others include diclofenac, buprenorphine, hormone patches (estrogen, contraceptive, testosterone), methy...
Source: The Tox Cave - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Pearls for Abscess Incision and Drainage
Part 2 in a Series
Abscess incision and drainage should be loved and adored by all emergency providers because another abscess is waiting just behind the curtain. This month we highlight general guidelines for abscess incision and drainage, and show how to treat one in the video below. We will follow up with some additional videos in the months to come focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.
Axillary abscess from hidradenitis. Photo by Martha Roberts.
The Approach
n Identification of an abscess appropriate fo...
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Patch Down the Hatch
A 42-year-old man presented with somnolence. Initial vital signs include: heart rate 54 bpm, blood pressure 92/68 mm/Hg, temperature 37°C, respiratory rate 6, pulse oximetry 90% on room air. Physical examination is remarkable for depressed level of consciousness, miosis, and bradypnea. His mental status and respiratory rate temporarily improved with the administration of 0.04 mg naloxone. He reports swallowing several “patches” in a suicide attempt.
What are examples of medications available as a transdermal patch? Compare the dose of drug delivered and the patch content.
Popular transdermal patches are listed bel...
Source: The Tox Cave - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Pearls for Abscess Incision and Drainage
Part 2 in a Series
Abscess incision and drainage should be loved and adored by all emergency providers because another abscess is waiting just behind the curtain. This month we highlight general guidelines for abscess incision and drainage, and show how to treat one in the video below. We will follow up with some additional videos in the months to come focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.
Axillary abscess from hidradenitis. Photo by Martha Roberts.
The Approach
n Identification of an abscess appropriate for I&D....
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
General Guidelines Related to Abscess Incision and Drainage: Part II
Greetings! We’re excited to continue our series on abscess incision and drainage. This procedure should be loved and adored, because another abscess is waiting just behind the curtain. This month we will highlight (in video format) the final cut of abscess incision and drainage. We will follow up with some additional videos in the months to follow focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.
The Approach
· Identification of an abscess appropriate for I&D
· If unsure, use ultrasound guide...
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying hot,...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Top stories in health and medicine, February 3, 2015
From MedPage Today:
An Ounce of Exercise, a Pound of Rehab. I first became aware of this “revolutionary” post-MI intervention as an intern — I was shadowing Bernard Lown, MD, the Nobel Prize winner, inventor of the defibrillator and introducer of lidocaine into medical practice.
Lower Lung Cancer Risk Seen in Nonsmokers on Metformin. Diabetic nonsmokers who had taken metformin had a decreased risk of lung cancer compared with metformin non-users.
Patients Themselves the Next Data Frontier. The next frontier of health information technology (IT) will involve more patient involvement in their own records ...
Source: Kevin, M.D. - Medical Weblog - February 3, 2015 Category: Journals (General) Authors: MedPage Today Tags: News Cancer Heart Source Type: blogs
Cardiac arrest, severe acidosis, and a bizarre ECG
A middle aged male had an unwitnessed PEA arrest associated with cocaine use. Whether there was a shockable rhythm prior to PEA is unknown, but he was never defibrillated. He received chest compressions with LUCAS and 3 doses of epinephrine, and was intubated by prehospital providers. He had intermittent pulses. Here is his initial ECG, with a pH of 6.50:The rhythm is uncertain: probably an accelerated junctional rhythm with RBBB and PVCs, but it could be an accelerated rhythm initiated in the left bundle, mimicking RBBB. It is important to ascertain the end of the QRS, which I attempt to do b...
Source: Dr. Smith's ECG Blog - January 14, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Eyebrow Laceration and Repair, If You Dare!
Picture this: It’s Dec. 31 at 11:59 p.m. You’re spending your designated holiday working the overnight. You’re eating some leftover fruitcake in the nurse’s lounge, and you see the following complaint sign into triage: “Drunk/face pain.”
This could mean just about anything when ethanol is on board. You lift your head just slightly over the computer screen and see a young gentleman staggering in the hall. His chart is labeled “SLC” for “streamline care.” Everyone knows that intoxicated patients are never appropriate for your streamline care area, but you decide to take a chance, and hope this guy has ...
Source: The Procedural Pause - December 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Eyebrow Laceration and Repair, If You Dare!
Picture this: It’s Dec. 31 at 11:59 p.m. You’re spending your designated holiday working the overnight. You’re eating some leftover fruitcake in the nurse’s lounge, and you see the following complaint sign into triage: “Drunk/face pain.”
This could mean just about anything when ethanol is on board. You lift your head just slightly over the computer screen and see a young gentleman staggering in the hall. His chart is labeled “SLC” for “streamline care.” Everyone knows that intoxicated patients are never appropriate for your streamline care area, but you decide to take a chance, and hope this guy ha...
Source: The Procedural Pause - December 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
