Certainly we've all taken care of of the patient with the chief complaint "possible seizure." Upon history and examination many of us will discover that the patient had syncope. So, the purpose of this post is to examine how we differentiate between convulsions in a epileptic seizure versus those that occur when a patient faints. Read on! What actually happens [...]
Allow me to present a common clinical scenario. The patient presents with right lower quadrant abdominal pain. Appendicitis is in the differential diagnosis. After an appropriately thorough H&P you have ascertained that it is not gastro/UTI/strep/pneumonia/constipation/porphyria/pregnancy etc., etc,. and obtain an ultrasound which shows a normal appendix but reveals the presence on enlarged mesenteric lymph nodes. from Radiopaedia.org [...]
The Case An athlete presents to the ED with an injured pinky finger. He says that he struck it on a teammate during practice and "it bent back." The pinky finger is abducted and jutting out at an extreme angle. It is making dad nauseous. The XRay shows the following: Diagnosis This is a Salter-Harris II fracture of the proximal [...]
In the ED we certainly see a significant number of head injuries. There are an estimated 1.7 million per year in the US. Fortunately most of these are not associated with intracranial bleeding. However, that certainly does not mean that there aren't important diagnoses to consider. Concussions have gained increased attention over the past decade thanks in part to a growing [...]
Check out the series of tweets from today's lecture on elevated intracranial pressure by Mary Frey, RN and Andrea Rinderknecht, MD at Cincinnati Children's Hospital Medical Center and the Division of Emergency Medicine. Check out these tweets for a summary of the many high yield teaching points. [View the story "Medical Video Review Live Tweet: Elevated intracranial pressure" on Storify]
I can't think of a recent shift in which I haven't placed a patient on oxygen. Given that, I wanted to share a brief teaching video on some of the various modalities for oxygen therapy in use in the Pediatric Emergency Department. Enjoy! http://vimeo.com/101403657
There are some things that we seem to do reflexively in the ED. Giving steroids to a patient with an asthma exacerbation is one of those things. Ask yourself the following question. Why do we do this? What is the evidence behind it? Can you cite any of the studies that lead to this common practice? I couldn’t fully elaborate [...]
The Differential Diagnosis for sore throat is quite long, though it is usually infectious. I will approach the approach that you should consider using when you approach the patient with a sore throat. I hope I don't face reproach for the gratuitous approach laden approach. Does the patient have respiratory distress? If the answer is yes to this one stop everything [...]
I know that performing an accurate and efficient joint exam in the ED can be challenging. Reviewing an ideal example in a "just in time" fashion can be a wonderful way to prepare for an upcoming patient. With that in mind I wanted to direct you to an excellent online resource from the Heart of England Foundation Trust’s Emergency Department. [...]
The case(s) You are seeing a pair of siblings that crashed into each other while jousting on their bikes. They were wearing helmets but both sustained forearm injuries. Both have swollen, tender forearms and you get X-Rays. And, no, there is not a BOGO discount. The Diagnosis Both patients have forearm fractures. Patient A has a buckle, or torus fracture. This [...]
