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Thunderclap headache, but negative CT: now what?

A 45 year old male comes into the ED with a sudden, severe headache. It started while he was at work yesterday and was the worst of his life. It started feeling a little better, but hasn’t totally gone away and his wife made him come to get checked out. There are enough concerning featuresRead more

Renal Colic & the CT scan: flip your patient prone!

A CT abd/pelvis without contrast is one of our go-to studies when evaluating for nephrolithiasis in a patient with acute flank pain. And it’s a really good one too–a recent meta-analysis of CT for suspected renal stone showed a sensitivity of 97% and a specificity of 95%. Pretty, pretty excellent. But have you ever wonderRead more

52 in 52: A Clinical Predictive Tool for Intra-Abdominal Trauma in Pediatric Patients

Title: Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma Article Citation: Holmes JF, Mao A, Awasthi S, McGahan JP, et al. Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med. 2009 Oct;54(4):528-33. PMID: 19250706 WhatRead more

Does intravenous contrast actually cause acute kidney injury?

Clinicians often consider alternate imaging modalities over contrast studies due to concern of acute kidney injury. In many situations, intravenous contrast can significantly improve the utility of a study. So, is contrast-induced nephropathy real? How often does acute kidney injury occur after a contrast study?   A recent study (Hinson et al. 2016) did aRead more

Subarachnoid Hemorrhage Revisited

Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency department. The thought of potentially missing a sentinel bleed from an aneurysm or AVM is something that keepsRead more

Did the Patient Finish Their Oral Contrast?

  CT scans are cited as a frequent source of delay to disposition of our patients in the emergency department. A contributing factor to this delay is the time it takes one to drink their oral contrast and to allow this contrast to travel throughout the intestines. The truth is, very few people actually needRead more

Blood Can Be Very Bad- Systematic Approach to Brain Ct

Post by @FTeranmd Using a systematic approach when reading a brain CT will make you a better doctor Because you only see what you’re looking for. Don’t believe? watch: http://goo.gl/6sIZ9x A simplified and systematic approach to the evaluation of non-contrast brain CT for the Emergency PhysycianRead more

Should You Stop Metformin After Iv Contrast?

Metformin has been known to be associated with increased incidence of lactic acidosis. Metformin is renally excreted. Increased Metformin concentration leads to increased risk of lactic acidosis. IV contrast causes nephropathy leading to increased blood levels of Metformin. Metformin + IV contrast = lactic acidosis = bad   This was the reasoning to having patientsRead more

A psych patient with abdominal tenderness and distention has the following abdominal film. Which drugs are radiopaque on xray?   Read more

8/30/13

PE in PregnancyRead more