Lunate and Perilunate dislocation

A 36F presenting with wrist pain after a fall on an outstretched hand. She has pain and swelling over the dorsal-radial aspect of her hand. Her xray is below, what is the diagnosis? It’s the spilled tea cup sign, but can you remember which dislocation it stands for?? It is the lunate dislocation. Both theRead more

High Altitude Illnesses, part 2

Yesterday, we learned about acute mountain sickness (AMS) and high altitude cerebral edema (HACE). Today we will tackle high altitude pulmonary edema (HAPE), the deadliest of the altitude illnesses. HAPE generally occurs above 3000m, but incidence varies at different altitudes. At 4500m the incidence ranges from 0.2 to 6%. Factors that place people at increasedRead more

High Altitude Illnesses, part 1

While we may not see as many wilderness related injuries in the concrete jungle of NYC, they are important to know. Especially when you ski out west, tick off the bucket list item of trekking K2 or when it inevitable shows up on the boards. Today we will talk about acute mountain sickness (AMS) andRead more

The 52 in 52 Review: The HEART score

Article citation: Backus BE, Six AJ, Kelder JC, Bosschaert MA, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. (Link to the article here)   What we already know about the topic: Chest pain is one of the most common complaints inRead more

Risk Stratify PE…Without the Gestalt

In the ED we think a lot about pulmonary embolism, and thus decision rules, d-dimers and CTAs. Because we have a low threshold to test for PE, we spend a fair amount of time trying to not get that CTA. There are a number of tools to risk stratify, but we commonly turn to Wells’,Read more

Oxygen for STEMI: Saving lives or Blowing Hot Air

We’ve all seen the patients roll in with EMS nasal cannula snug against their nares. “Why are they on oxygen?” EMS response, “I don’t know he was having chest pain.” EKG shows STEMI! The last thing you’re thinking is whether their nasal cannula should be adjusted but maybe they don’t need the oxygen at all.Read more

What Diagnosis Lies Beneath? Medical Legal Basics

Seeing our alumni at ACEP was amazing! It seems like Life after Residency is sweet: making your own schedule, working with great colleagues, no more pushing people to CT, developing startups! The sky is the limit but then there’s the inevitable question, the question that lurks in the back of my mind since days ofRead more

EKGs that make you go Hmmm: Toxidrome EKGs

Overdose and EKGs they start to all look the same…widened QRS, that thing in aVR…vfib (hopefully not). Here’s a highlight of key EKG findings associated with a few toxidromes: (1) Bupropion overdose (2) TCA overdose (3) Digoxin Toxicity Bupropion Overdose: See wide-complex tachydysrhythmias-widened QRS and QT intervals; case reports have shown cardiogenic shock Consider inRead more

Compartment Syndrome: UNDER PRESSURE

Dr. David Forsh’s review yesterday of compartment syndrome made me realize how rarely we see this life-threatening diagnosis. So what do we need to know? What’s the etiology of compartment syndrome? Majority cases 2/2 Fractures (75%); the rest are soft tissue injuries from causes such as: snake bites, seizures, burns, tourniquets,… People with coagulopathy suchRead more

1 hour Troponin: The new TnT for Chest Pain?

Chest pain…everyone gets it…sometimes when a patient says they have chest pain I get chest pain. What’s the solution to this chest pain epidemic? Troponins! Well not so fast because they aren’t fast…especially when the lab tells you, “no troponins here…” Dr. Jean Sun Reviewed Troponins beautifully in her posts Troponins Part I, Part II,Read more