Should Fluoro Be Your Go-to?
Part One in a Three-Part Series
How many times have you wasted at least 30 minutes (if not more) digging around in a patient’s foot to remove a sewing needle or piece of metal or glass? Or maybe the question is, how many of you have immediately referred the patient to podiatry because foreign body removal isn’t an ED procedure?
Foreign body removal may not be emergent, but it can be urgent. Items left in the skin can cause complications and should be removed whenever possible to decrease risk of infection or other future issues.
Foreign body of the left foot in a 56-year-old woman.
The ED is the r...
Source: The Procedural Pause - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series
Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.
Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.
Although em...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series
Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.
Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.
Altho...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Emergency Department (In)efficiency - Why patients wait 6 hours...and die in the waiting room.
I've worked at more than a few places...both EDs and urgent cares. I can finally say I now fully appreciate the difference between a 'physician efficient' ED and...one that's not.One of my gripes about working in the ED as a doctor is...the place isn't set up to maximize physician efficiency. Sure, they expect you to see 2.5 patients an hour...but when it takes 20 minutes to log into the various computer programs, trouble shoot the printing process, and then find said printout to sign and place with the chart (if you can find the chart)...there's no way the "goal" of 2.5 patients can be reached.Let's take last night......t...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Emergency Department (In)efficiency - Why patients wait 6 hours...and die in the waiting room.
I've worked at more than a few places...both EDs and urgent cares. I can finally say I now fully appreciate the difference between a 'physician efficient' ED and...one that's not.One of my gripes about working in the ED as a doctor is...the place isn't set up to maximize physician efficiency. Sure, they expect you to see 2.5 patients an hour...but when it takes 20 minutes to log into the various computer programs, trouble shoot the printing process, and then find said printout to sign and place with the chart (if you can find the chart)...there's no way the "goal" of 2.5 patients can be reached.Let's take last night......t...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Can I Tap That?
Part 1 of a Series
How often do you come in contact with a patient whose chief complaint is knee pain? How often can you actually to do something about it? Collectively as emergency providers, we do not typically fix these types of injuries in the ED, and at times, it is not even certain if we actually diagnose knee pain properly. The truth of the matter is simply that we can diagnose it correctly, help our patients feel better, and give them some answers.
Frequently, traumatic knee pain can be diagnosed as a contusion, generalized strain, or sprain. Rest, ice, compression, elevation, and NSAIDS are often prescribed...
Source: The Procedural Pause - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Low-Tech Solution to Diagnosing a Serious Problem
An elderly patient was brought in short of breath.
The x-ray finding was not seen on first glance. A colleague mentioned that his mentor recommended always rotating the film to the left and right as a better way to see a pneumothorax on plain radiographs. It seems human eyes are better at seeing horizontal lines than vertical ones. In fact, that simple maneuver seemed to make the pleural line pop. A dark viewing room makes the line stand out even more.
The patient was sent for CT to confirm the finding and to evaluate for adherence to the chest wall. Remember that ultrasound has been shown to have gre...
Source: Lions and Tigers and Bears - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can I Tap That?
Part 1 of a Series
How often do you come in contact with a patient whose chief complaint is knee pain? How often can you actually to do something about it? Collectively as emergency providers, we do not typically fix these types of injuries in the ED, and at times, it is not even certain if we actually diagnose knee pain properly. The truth of the matter is simply that we can diagnose it correctly, help our patients feel better, and give them some answers.
Frequently, traumatic knee pain can be diagnosed as a contusion, generalized strain, or sprain. Rest, ice, compression, elevation, and NSAIDS are often presc...
Source: The Procedural Pause - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Low-Tech Solution to Diagnosing a Serious Problem
An elderly patient was brought in short of breath.
The x-ray finding was not seen on first glance. A colleague mentioned that his mentor recommended always rotating the film to the left and right as a better way to see a pneumothorax on plain radiographs. It seems human eyes are better at seeing horizontal lines than vertical ones. In fact, that simple maneuver seemed to make the pleural line pop. A dark viewing room makes the line stand out even more.
The patient was sent for CT to confirm the finding and to evaluate for adherence to the chest wall. Remember that ultrasound has been shown t...
Source: Lions and Tigers and Bears - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Just Gave Out
This elderly patient fell after his right knee gave out while walking. Besides impressive calcification of the popliteal artery, what is wrong with his knee?
He has a comminuted tibial plateau fracture. The biggest radiographic clue is the meniscal line on the cross-table lateral. This is blood and fat in the joint. Fat droplets would be floating on top if you drained this effusion and placed the blood in a basin. You should always assume there is a fracture if you see this.
Another subtle clue includes an abnormal increase in density at the top of the tibia, which can come from an overlying fractu...
Source: Lions and Tigers and Bears - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Just Gave Out
This elderly patient fell after his right knee gave out while walking. Besides impressive calcification of the popliteal artery, what is wrong with his knee?
He has a comminuted tibial plateau fracture. The biggest radiographic clue is the meniscal line on the cross-table lateral. This is blood and fat in the joint. Fat droplets would be floating on top if you drained this effusion and placed the blood in a basin. You should always assume there is a fracture if you see this.
Another subtle clue includes an abnormal increase in density at the top of the tibia, which can come from an overl...
Source: Lions and Tigers and Bears - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Emergency Transvenous Cardiac Pacing
This case was provided by one of our fine 5th year EM/IM residents, Rachael Krob MD. The description of the method for inserting a pacing wire is by one of our fine 3rd year EM residents, Mark Sandefur MD.CaseAn elderly male was found on the floor with altered mental status. When EMS arrived, he was obtunded but occasionally able to answer yes/no questions. He was found to be bradycardic in the 20's-30’s. Glucose was normal. A prehospital 12-lead was recorded; unfortunately, only half of it made it into the chart:There is a slow indeterminate rhythm with a right bundle branch block morphology. The medics r...
Source: Dr. Smith's ECG Blog - July 21, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Test your medicine knowledge: 40-year-old man with headache and epistaxis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 40-year-old man is admitted to the emergency department with a 1-day history of headache and epistaxis. He has had type 1 diabetes mellitus requiring insulin for 30 years and two episodes of ketoacidosis in the past year.
On physical examination, temperature is 36.0 °C (96.8 °F), blood pressure is 100/70 mm Hg, pulse rate is 120/min, and respiration rate is 22/min. There is mild proptosis of the right eye with periorbital edema and a black eschar on the inferior turbinate of the right nostril. Skin examinati...
Source: Kevin, M.D. - Medical Weblog - July 4, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
Just Say 'No' to X-Ray
A 27-year-old woman came into the ED in the middle of the night complaining of not being able to sleep. She was sure the continuous right-sided foreign body sensation under the angle of her jaw came from a fish bone stabbing her during a late-night dinner. A CT revealed an embedded fish bone. ENT removed the foreign body endoscopically, and she was discharged on oral antibiotics, and had an uneventful follow-up visit a few days later.
The question with my residents always seems to be, "Should we get an x-ray?" And my answer now is, "No."
It is certainly possible that careful inspection of the ...
Source: Lions and Tigers and Bears - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Just Say 'No' to X-Ray
A 27-year-old woman came into the ED in the middle of the night complaining of not being able to sleep. She was sure the continuous right-sided foreign body sensation under the angle of her jaw came from a fish bone stabbing her during a late-night dinner. A CT revealed an embedded fish bone. ENT removed the foreign body endoscopically, and she was discharged on oral antibiotics, and had an uneventful follow-up visit a few days later.
The question with my residents always seems to be, "Should we get an x-ray?" And my answer now is, "No."
It is certainly possible that careful inspection o...
Source: Lions and Tigers and Bears - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
