Intro: Distal digital trauma is common and often associated with cosmetic and functional disturbances.Underlying lacerations are often masked by gross deformities of the nail and hematomas.Crush and blunt force injuries are usually the mechanisms involved with nail deformities and underlying nailbed injuries.Treatment can often necessitate nail removal based on clinical judgement and suspicion of underlying …
Title: Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine. J Hosp Med. 2019 Oct 1;14(10):591-601. doi: 10.12788/jhm.3197. Epub 2019 Jun 10. What is already known about this topic?Previous meta-analysis with multiple RCTs have shown that ultrasound-guided LP is superior to landmark-guided LP for …
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26 year old male of filipino descent presents with diffuse motor weakness that was present upon waking this morning at 0400. Patient reports he was of normal health and asymptomatic last night and in the preceding days. Patient denied recent infectious symptoms such as diarrhea, cough, congestion, fevers, chills, urinary changes, rashes or insect bites. …
Continue reading Case of the Month: The paralyzed 26 year old.
38 year old female presents to the Emergency Department with reports of left eye pain, discomfort and haziness to her vision. Like the excellent physician that you are, you take a look at her eye. Is the eye red with a weird line on the front? Or does the patient have injected conjunctiva, a ciliary …
Title: The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients. Ann Emerg Med. 2019 Dec 24. pii: S0196-0644(19)31236-3. doi: 10.1016/j.annemergmed.2019.09.018. What is already known about this topic?Previous studies have shown midline catheters inserted in upper arm veins have lower complication rates compared to central lines, and high rates of successful placement in …
Continue reading Midlines in the Emergency Department; a literature review
Title: Use of Handheld Point-of-Care Ultrasound in Emergency Airway Management. Chest. 2020 Sep 21;S0012-3692(20)34501-3. doi: 10.1016/j.chest.2020.09.083. What is already known about this topic?Studies on traditional clinical examination techniques, such as modified Mallampati score, thyromental distance, neck range of motion, and mouth opening, have shown the limited predictive performance of for predicting difficult airways.Confirmation of endotracheal tube (ETT) …
Continue reading Point of Care Ultrasound in an Emergent Airway; a literature review
Whether for Journal Club, or while on the road of lifelong learning, being able to read journal articles is a core skill physicians must master. While it is tempting to merely read guidelines, summaries, or others’ analyses of articles, this will not help you become the best possible physician you can be. Choosing and evaluating …
As ED doctors, we’re often handed EKGs every few minutes. Our minds initially will always go to ST elevations and possible myocardial infarctions. With this in mind however, what are the other, lesser seen variants that are equally as dangerous and also warrant immediate catheterization? Hyper-acute T waves Before starting to discuss STEMI equivalents, let’s …
Introduction Throughout the worldwide pandemic of COVID, the general understanding became that pediatric patients were not only less susceptible to the virus but also to the clinical symptoms that accompany it. Albeit rare, Multisystem Inflammatory Syndrome in Children (MIS-C) is a relatively new differential diagnosis that does not necessarily need positive COVID testing and in …
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http://momontheblock.com/ 26-year-old multiparous female approximately 25 weeks gravid presents to the Emergency Room with palpitations. Patient reports that this feels similar to an episode she had during her first pregnancy that resolved after 18 mg of Adenosine. Patient states she was watching television on the couch when symptoms began. Patient reports feeling some mild chest …
Continue reading Case of the Month: Management of Atrial Tachyarrhythmia in Pregnancy
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