Daily Em Pearl, 4/30/12

A middle aged man p/w constipation x4days, no n/v/fever. He is on methadone 120mg PO qday, chronically, 2/2 h/o IVDU. He has tried lots of OTCs, as well as prune juice and metamucil w/o relief. How can you help?Read more

Daily Em Pearl 4/29/12

A middle aged woman p/w R-shoulder pain after falling on her outstretched arm. You order a plain film to eval for fracture or dislocation. What do you see? R-shoulder plain film  Read more

Daily Em Pearl, 4/28/12

A teenaged woman presents at 32weeks gestation, c/o fingertip pain after experiencing a brief electric shock at home. How do you evaluate and care for this patient?  Read more

Daily Em Pearl, 4/27/12

A middle-aged lady presents to the ED but won’t tell the triage nurse what’s wrong. “I need to see a doctor, is all.” Turns out she has a rectal foreign body. On xray it appears to be an apple. On digital exam you can just feel the bottom of the apple with the distal tipRead more

Daily Em Pearl, 4/26/12

How does kayexalate work? Is it useful in the ED?  Read more

Daily Em Pearl, 4/25/12

How do you evaluate for an ectopic pregnancy (versus an intrauterine pregnancy)?  Read more

Gel Contamination

On April 18 the FDA released an alert regarding Other-Sonic Generic Ultrasound Transmission Gel, manufactured by Pharmaceutical Innovations Inc. The ultrasound gel was found to be contaminated with Pseudomonas aeruginosa and Klebsiella oxytoca. According to the FDA Press Announcement, U.S. Marshals, acting at the request of the Food and Drug Administration, have seized Other-Sonic GenericRead more

Daily Em Pearl, 4/24/12

A young man presents with a slam dunk appendicitis. You start IV abx, order pre-op labs and request surg to come see the patient. Surgery chats with the young fellow, lays hands on his abd and reviews the labs and CT. They recommend IV abx x24-48hours and no surgery if no worsening. Your med studentRead more

Daily Em Pearl, 4/23/12

A young man is brought in by his buddy because he’s “freaking out.” He isn’t making any sense to you but expresses fear that he’s going to die. He is having visual hallucinations. The friend reports they were having “some fun” with nutmeg. On exam, the young man’s vitals are as follows: 99.9F (oral)  195/100Read more

Daily Em Pearl, 4/22/12

Abscess: After incision and drainage, do you pack or not? What does the literature say?Read more