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When assessing patients with difficult peripheral venous access it is often helpful to look in the medial upper arm. Here, the brachial artery (A) and veins (V) are predictably located between the biceps and brachialis muscles. The median nerve (N) resides there as well. Here’s a plate from Grey’s Anatomy for some perspective: So howRead more

32F no PMH, p/w fever and abdominal pain x 5 days. Seen 5 days ago at OSH and treated for UTI w bactrim. Seen 2 days later, switched to doxycycline for presumed PID. GC/chlamydia negative.  Returns today w persistent pain and fever. Pain is lower, bilateral, R>L with mild distention. No urinary or vaginal symptoms.Read more

Kanavel’s sign: clinical sign found in patients with flexor tenosynovitis (infection of flexor tendon sheath of hand) –       involved digit kept in flexed position –       tenderness to palpation over tendor sheath –       pain with passive extension of digit –       fusiform swelling of digit     http://www.orthobullets.com/hand/6105/pyogenic-flexor-tenosynovitisRead more

Ultrasound guided LP   Equipment needed: –       high-frequency (small parts linear probe) for patients with normal weight –       low-frequency 2-4 MHZ probe (abdominal curvilinear probe) for obese patients –       transducer gel –       skin marking pen –       LP tray   Positioning: left lateral decubitus or seated position   Technique: 1-   Identify spinous process which signifies theRead more

10d male p/w R eye tearing and discharge x1 day. Today purulent. Born FT via NSVD, uncomplicated pregnancy and delivery. No fever. No vomiting, diarrhea. No URI. Taking good PO.  On exam, AFVSS, R eye diffuse soft tissue swelling, crusting to lashes, conjunctiva injected with purulent discharge:   Chlamydia Conjunctivitis in Newborn Transmission – fromRead more

55 yo F presents with shoulder pain after fall from bicycle: Also known as “luxatio erecta”  – to place upward   Inferior shoulder Dislocation     Mechanism of injury: fall and sudden grasp of object above head resulting in hyperabduction Presentation: Patients hold arm above head and is unable to adduct, looks like a personRead more

Congrats to all that have matched today!   Interestingly enough, did you know that Lloyd Shapley and Alvin Roth won the Nobel Prize in Economic Sciences in 2012 for their research over many decades about stable matching, which is used in the NRMP’s Match algorithm?   Check it out: http://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/2012/popular-economicsciences2012.pdfRead more

A 3yo M comes into your ED around midnight after a fall off a stool onto his face. He has been vomiting, is bradycardic in triage to the 50s so is brought into your pediatric RESUS bay. Mom states that his eyes “look weird”. On exam, pt is scared but awake and alert, with fullRead more

Thanks to our PEM fellow Dr. Michelle Vasquez for a great morning report today! Some questions that came up afterwards: Is there a difference in drowning with salt vs freshwater? -turns out that while there are blood and electrolyte shifts, the amount of water needed to induce a clinically significant difference between the two types ofRead more

A young patient comes into your RESUS area complaining of palpitations, and you get handed this EKG. What do you do?Read more