Anaphylaxis, chest pain, and ST elevation in aVR
Sent by anonymous, written by Pendell MeyersA man in his late 40s presented to the ED with concern for allergic reaction after accidentally eating a potential allergen, then developing an itchy full body rash and diarrhea. In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms.During active chest pain an ECG was recorded:Meyers ECG interpretation: Sinus tachycardia, normal QRS complex, STD in V2-V6, I, II, III and aVF. R...
Source: Dr. Smith's ECG Blog - March 1, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Antibody positive autoimmune encephalitis presenting with faciobrachial dystonic seizures-Case Report
63 year old male presented with new onset faciobrachial dystonic seizures. Imaging showed T2 Flair hyperintensity in left hippocampus. Possibility of autoimmune encephalitis was considered and we went for CSF autoantibody study.Result came as positive for LGI 1 (Leucine rich Glioma Inactivated-1) antibody in CSF.We also did a paraneoplastic work up to rule out any underlying malignancy. But was unyielding. Patient was treated with steroid pulse with methylprednisolone for 5 days. Subsequently, he was continued on oral steroids. Patient improved. No further seizure episodes. Patient is being kept on follow...
Source: Sumer's Radiology Site - December 9, 2018 Category: Radiology Authors: Sumer Sethi Source Type: blogs
Two cortisone stories involving Peekaboo and yours truly …
First, the news about Peekaboo. When I met with the vet a few days ago, he repeated that we wouldn’t be able to give her the current anti-inflammatory drug forever. Too bad, since she eagerly takes it in her wet food in the morning, and it seems to have no side effects. Oh well.
He suggested I substitute it with a drug called Contramal, which is basically Tramadol, and with another one that contains quercetin (I checked it out, it’s okay, so she’s on that now).
Tramadol is a different story. That’s the drug that Piccolo was on for some time last summer, and I am CONVINCED (although I have no proof, ...
Source: Margaret's Corner - September 7, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll cortisone Medrol Source Type: blogs
Tropical Travel Trouble 008 Total TB Extravaganza
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 008
Peer Reviewer Dr McBride ID physician, Wisconsin
TB affects 1/3rd of the population and one patient dies every 20 seconds from TB. Without treatment 50% of pulmonary TB patients will be dead in 5 years. In low to middle income countries both TB and HIV can be ubiquitous, poor compliance can lead to drug resistance and malnourished infants are highly susceptible. TB can be very complex and this post will hopefully give you the backbone to TB m...
Source: Life in the Fast Lane - June 16, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine Genexpert meningitis TB TB meningitis Tuberculosis Source Type: blogs
How To Prevent Burnout: A Case in Point. Frederick This One.
By MARTIN A. SAMUELS
I posted an essay on The Health Care Blog (entitled The Prevention of Physician Burnout: A Nine Step Program. Here is an example of how this works. Recall the wonderful children’s book by Leo Lionni, Frederick. Let me remind you of it.
A family of mice begins to store away food and supplies for the long winter ahead. Most are practical and gather corn, grains, and straw. One of the mice, Frederick, instead collects rays of sun, colors of the rainbow, and words to remember. When winter arrives the family begins to use up their practical supplies. They become irritable and angry and don’t ...
Source: The Health Care Blog - August 25, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
How To Prevent Burnout. Frederick This One.
By MARTIN A. SAMUELS
I posted an essay on The Health Care Blog entitled The Prevention of Physician Burnout: A Nine Step Program. Here is an example of how this works. Recall the wonderful children’s book by Leo Lionni, Frederick. Let me remind you of it.
A family of mice begins to store away food and supplies for the long winter ahead. Most are practical and gather corn, grains, and straw. One of the mice, Frederick, instead collects rays of sun, colors of the rainbow, and words to remember. When winter arrives the family begins to use up their practical supplies. They become irritable and angry and don’t h...
Source: The Health Care Blog - August 25, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Burnout Frederick Martin Samuels Source Type: blogs
Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Managing Sacroiliac Pain in the Emergency Department
I have been treating specifically localized sacroiliac pain with injections of bupivacaine and methylprednisolone for several years. It seems that every few months I have a patient who presents with localized pain and can benefit from this procedure. The only patients on whom I perform these injections are those who localize their pain to the back dimples, also known as the dimples of Venus or fossae lumbales laterales.
Anatomically, it is known that beneath these dimples are the superior aspects of the sacroiliac joints. These sacral sulci are anatomically just above the posterior superior iliac spine and also the ju...
Source: M2E Too! Mellick's Multimedia EduBlog - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Managing Sacroiliac Pain in the Emergency Department
I have been treating specifically localized sacroiliac pain with injections of bupivacaine and methylprednisolone for several years. It seems that every few months I have a patient who presents with localized pain and can benefit from this procedure. The only patients on whom I perform these injections are those who localize their pain to the back dimples, also known as the dimples of Venus or fossae lumbales laterales.
Anatomically, it is known that beneath these dimples are the superior aspects of the sacroiliac joints. These sacral sulci are anatomically just above the posterior superior iliac spine and also the junc...
Source: M2E Too! Mellick's Multimedia EduBlog - November 2, 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
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
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.
Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this area is l...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
