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Shoulder Shimmy

33-year-old G1 P0 at 39 weeks with a history gestational diabetes presents in labor. After delivering the head you see it retract slightly (turtle sign). On the next push you are unable to delivery the anterior shoulder with gentle downward traction. Shoulder dystocia typically occurs when the anterior shoulder impacts on the pubic symphysis, lessRead more

52 in 52: POCUS in Trauma

Article Citation: Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006 Sep;48(3):227-35. PMID: 16934640 Resident Reviewer: Courtney Cassella What we already know about the topic Trauma is anRead more

NEC, volvulus, pyloric stenosis, oh my!

This is a review of specific pediatric entities that may cause abdominal pain, bloody diarrhea, or vomiting. The following lists are not comprehensive and emergency physicians should consider a broad differential based on symptoms and presentation. The aim of this pearl is to familiarize us with these select pediatric conditions. Case courtesy of A.Prof FrankRead more

In the zone

The concept of “flow” or “being in the zone” is discussed often in sports but can extend to any activity. Being in the zone is described as an elevated yet effortless sense of concentration.1 Furthermore, it is considered to be intrinsically rewarding. How can we as emergency providers maximize our chances of being in theRead more

Bites Bites Bites

Animal Bites (Cat, Dog, Monkey, Lizard, Snake) Quick bullets to prep for in-training, let’s review Management for ALL animal bites X-ray if suspect foreign body Remove teeth Routine wound care/irrigation Update tetanus   Cats Pathogens: Pasteurella, Bartonella (cat scratch) Treatment Leave the wound open (don’t suture) Strongly consider antibiotics for ALL bites  Amoxicillin/clavulanate PCN allergic:Read more

52 in 52: Laboratory Risk Indicator For Necrotizing Fasciitis Score

Article Citation: Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004 Jul;32(7):1535-41. PMID: 15241098 Resident Reviewer: Courtney Cassella What we already know about the topic Necrotizing fasciitis is a severe softRead more

Tricky Orthopedics

That being said, let’s go through some commonly tested and easily confused orthopedic entities… Salter-Harris Classification http://orthoinfo.aaos.org/topic.cfm?topic=A00040 Type 1 – Slipped (Physis) Type 2 – Above (metaphysis) Type 3 – Lower (Epiphysis) Type 4 – Transverse all 3 Type 5 – Rammed (crush) Hand/Wrist injuries Scapholunate vs. Perilunate vs. Lunate Dislocation Mechanism for all 3:Read more

Hypernatremia

Clinical Scenario:  A 66-year-old male with a past medical history of traumatic brain injury and frequent urinary tract infections sent from his nursing home with hypernatremia. On a routine blood draw he was found to have hypernatremia to 160. His mental status is unchanged. How do you correct his hypernatremia? Hypernatremia is caused by ExcessiveRead more

52 in 52: Rate vs. Rhythm for A fib

Article Citation: Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, et al; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002 Dec 5;347(23):1825-33. PMID: 12466506 Resident Reviewer: Courtney Cassella What we already know about the topic There areRead more

Low Back Pain Exam

Clinical Scenario: A 28-year-old male with no significant past medical history presents with low back pain for 6 days. His pain started after playing soccer. The pain is severe, sharp, and radiates down the left leg. The pain limits his ability to walk. He has been taking ibuprofen every 6 hours without relief. Today heRead more