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Dengue fever (DF) is a viral infection (one of four serotypes) transmitted by mosquitos in endemic regions of the world.  Classic DF is an acute febrile illness associated with HA, retro-orbital pain and muscle/joint pains.  Differential diagnoses include malaria, leptospirosis, and typhoid fever.  Treatment is supportive with adequate hydration and acetaminophen for HA, myalgia, andRead more

Cardiac Arrest Ultrasound AIUM 2014

As promised, references from today’s lecture. Background 1. Arntfield RT, and Millington SJ. Point of care cardiac ultrasound applications in the emergency department and intensive care unit–a review. Curr Cardiol Rev. 2012, May;8(2): 98-108. 2. Bocka JJ, Overton DT, and Hauser A. Electromechanical dissociation in human beings: an echocardiographic evaluation. Ann Emerg Med. 1988, May;17(5):450-2.Read more

To Bleed or Not to Bleed

Extracranial internal carotid artery dissection can cause ischemic stroke by thrombus formation or thromboembolism and subsequent arterial occlusion.  In fact, it is the 2nd most common etiology of strokes in patients younger than 45 years.  Traditionally, anticoagulant or antiplatelet agents have been administered to prevent ischemic insults, but does increased bleeding risk outweigh the benefitsRead more

Summer’s Around the Corner…need to Buff Up?

We’ve all heard that lidocaine buffered with sodium bicarbonate makes the local anesthetic closer to physiologic pH.  This in turn decreases time of onset and infiltration pain.  However, upon further investigation, this may not be so true. Hobeich et al. concluded that 2% lidocaine with epinephrine buffered with 5% or 10% sodium bicarbonate did notRead more

Starring Samuel L. Jackson in the Negotiator

When negotiations break down with an undifferentiated agitated patient, before you reach for your trusty 5:2, consider ziprasidone (Geodon). Martel et al. concluded that droperidol or ziprasidone achieved better sedation of the undifferentiated agitated ED patient than midazolam.  But the onset of sedation was delayed with ziprasidone relative to the other agents.  Details of theRead more


Herpetic Whitlow –       Viral infection of hand caused by inoculation of HSV into broken skin Hand pain disproportionate to clinical presentation Associated with influenza-like illness Clear vesicles coalesce and become purulent but pulp space is soft (versus tense in bacterial infection) (Figure 1) Beware of look-alikes (i.e. paronychia (Figure 2), felon (Figure 3)) as managementRead more

I Scream, You Scream, We All Scream for Lactate.

We love our lactates and want to protect them from every slip and fall.  But are they a bit more resilient than we think? Jones et al. concluded that point-of-care venous lactate in healthy patients does not significantly change over a course of 15 minutes either at -1˚ C or 23˚ C (room temperature) asRead more

Blood Can Be Very Bad…indeed

Interpreting head CT’s can be daunting.  But it doesn’t have to be.  Just remember, “Blood Can Be Very Bad”. Blood –       blood up to 1 week old looks hyperdense to brain –       blood 1-4 weeks old looks isodense to brain –       blood after 4 weeks old looks hypodense to brain –       Types of intracranial hemorrhage:Read more

L is for the Way You Lorazepam Me

Consider giving 2mg of lorazepam to your patient who’s back at baseline after one alcohol withdrawal seizure to possibly prevent recurrent seizures.  This may even save you an admission as long as the patient has been at baseline without signs or symptoms of alcohol withdrawal for at least 6 hours. D’Onofrio et al. performed aRead more


Distinguishing early necrotizing fasciitis from severe cellulitis is difficult.  In 2004, Wong et al proposed the LRINEC(Laboratory Risk Indicator for Necrotizing Fasciitis) score as a means to distinguish necrotizing fasciitis from other soft tissue infections. The LRINEC Score C-reactive protein (mg/L)    <150 (or <1.5 mg/dL) 0  ≥150 (or ≥1.5 mg/dL) 4 Total white bloodRead more