daily EM pearl, 4/13/12

A young woman presents with a painful wrist, no trauma history. On exam, there is an effusion present, no erythema and tenderness to palpation. She is afebrile. How do you rule out a septic joint? What pathogen should be considered?  Read more

Ovarian Torsion

Although we tend to suspect torsion only in cases where there is ovarian enlargement, cyst, etc., there are a number of studies that show these are not reliable (sensitive or specific) indicators of torsion. Radiology reports often seem to hedge and note that ovarian torsion is a clinical diagnosis because the test characteristics of ultrasoundRead more

daily EM pearl 4/12/12

An elderly person p/w R-knee pain after stepping off the curb a few days ago. There is  mild swelling and the patient does not like to bear weight on the extremity. You order a plain film of the knee and it looks okay. When you present to your seasoned attending, she tells you’ve missed a fracture. Where?  Read more

daily EM pearl 4/11/12

You are caring for a 7mo child who is not moving the LUE; a plain film shows a fracture. Child maltreatment is high on your differential. You want to order a skeletal survey and your medical student wants to know precisely what you’re looking for on your survey. You say…  Read more

daily EM pearl, 4/10/12

A middle aged man presents complaining of foreign body sensation in his eye, subjective fever, pain with spontaneous eye opening and ipsilateral ear pain. On exam, you don’t see any foreign bodies, but you do note multiple corneal infiltrates. What’s going on?                 Epidermal keratoconjunctivitis. Caused by adenovirusRead more

daily EM pearl, 4/9/12

28 y.o. male felt his left knee “pop” after landing from a jump while playing basketball. Knee exam revealed limited knee extension. X-ray is shown in the link below. Diagnosis?    more

Daily EM Pearl 4/6

A 53yoM presents with bilateral TMJ dislocation which he has had in the past. He receives procedural sedation and multiple attempts at reduction using conventional methods with no success. What can be done now?Read more

Daily EM Pearl 4/5

A 60yoM h/o A-Fib on Dabigatran, took his medication this morning and then slipped in the shower 10 mins later, hitting his head with +LOC. He did not want to come to the emergency room at first but approximately 14 hours later, complains of worsening headache, nausea, and vomiting. CT shows a parietal subdural hematoma.Read more

Daily EM Pearl 4/4

Inspired by Tali Porat’s M&M What is the most consistant ultrasound finding in an ovarian torsion? . . . Answer: Unilateral ovarian enlargement (>4cm). Up to 73% of these has a complex adnexal or pelvoabdominal mass, which can be predominantly cystic, solid, or both. Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation.Read more

Daily EM Pearl 4/3

A 79yoM with history of CAD s/p PCI/CABG years ago, Parkinson Disease presents with chest pain. ECG is shown below. Your ECG machine is not malfunctioning, the tech has not made a mistake, and the patient is laying calmly (no shivering or tremor). What is causing this abnormal ECG appearance, what can be done toRead more