Flexor Tenosynovitis

Tenosynovitis = inflammation of a tendon and its sheath.  Most acute cases of flexor tenosynovitis (FT) are infectious but may also be secondary to inflammation from noninfectious cause (e.g. diabetes, overuse, arthritis) Infectious tenosynovitis May be result of trauma with direct inoculation (eg, laceration, puncture or bite), contiguous spread from infected adjacent soft tissues, orRead more

Tick-borne Illness – Not All Lyme

27M h/o sickle cell anemia presents with high fevers, sweats, HA, muscle aches, N/V.  Recent camping trip in New England.  Blood smear shows the following:   Diagnosis? What complications would you worry about?  Read more

Interesting Studies About Learners in the Emergency Department

The following study results about learners in the ED are department specific for each study, though they offer a sense of general perspective on the issues at hand. –  Medical students do not affect attending or resident productivity – One resident with one attending will see more patients than the attending alone – mid-level providersRead more

Mid-2014 Updates in Emergency Medicine

Some 2014 updates so far… – age adjusted d-dimer – ultrasound assisted, catheter directed thrombolysis – thrombolysis for RV dysfunction (intermediate risk PE) – sepsis treatment: early recognition, early antibiotics, and attentive care – restrictive transfusion (Hgb 7-8) – Good Outcome For Attempted Resuscitation (GO-FAR) score for predicted neuro outcome of in-hospital arrests – palliativeRead more

Management of Traumatic Subarachnoid Hemorrhage

Prioritization of following steps is based on individual patient needs: 1. Assess stability – stabilize – neuroprotective intubation as needed 2. Determine secondary damage – neuro exam, including GCS – CT scan 3. Treat (may begin simultaneously with 1 and 2) – reverse anticoagulation as necessary – prevent potential seizures – minimize cerebral edema –Read more

Medical Statistics – a Primer on Concepts

Medical statistics review (assuming some basic familiarity): Mean (average), median (middle number), mode (most common number) Sensitivity and specificity depend on a specific, pre-determined test. Also, they do NOT depend on prevalence of the condition being tested for. Positive predictive value and negative predictive value depend on the prevalence of the condition being tested for.Read more

The Normotensive Pulmonary Embolism Patient

Early death (within 7-30 days) in PE patients is concerning. It is relatively easy to identify high-risk PE patients, defined by abnormal vitals SBP < 90 or drop in SBP by 40 for at least 5 min. Normotensive patients with poor prognostic indicators include (statistically significant odds ratios): – SBP between 90-100 (OR 2.45) –Read more

Criteria for St Segment Elevation

Different criteria exist based on gender, age, and ethnicity: – new 1 mm of STE in 2 contiguous leads except for V2-V3 – 2 mm of STE in V2-V3 in men > or = 40 – 2.5 mm of STE in V2-V3 in men < 40 – 1.5 mm STE in V2-V3 in women – strongly considerRead more

Young Female with Hemoptysis

A 24 year old female from Europe presents with progressive shortness of breath and hemoptysis. O2 sat is 94%. CXR is clear. PSH includes silicone implants in gluteal area. Meds include OCPs. Travel from Eastern Europe 2 months ago. D-dimer is negative. CTA is negative for embolus. What is the diagnosis?Read more

A Pediatric Pearl

This week, PECARN published a study that determined that isolated loss of consciousness (LOC) is not a strong enough predictive factor for a clinically significant traumatic brain injury, which they define as requiring intubation, extended inpatient observation, and/or neurosurgical intervention (rate of  0.5% (95% CI, 0.2-0.8; 13 of 2780). The rate is slightly higher forRead more