Hyperpronation for Nursemaid’s elbow reduction

“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.” -Kailash Satyarthi   Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not useRead 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

Does Emergency Department crowding affect inpatient mortality?

The short answer is that it might. While it may not be surprising to you that ED crowding is detrimental to overall patient care, it may surprise you that it could be linked to inpatient mortality. At least a few studies have been looking in that direction.   A 2013 study with almost 1 millionRead more

The 52 in 52 Review: Noninvasive ventilation for COPD exacerbations

“Ventilation is the profound secret of existence” – Peter Sloterdijk   Article Citation: Brochard L, Mancebo J, Wysocki M, Lofaso F, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995 Sep 28;333(13):817-22. PMID: 7651472   What we already know about the topic: Noninvasive ventilation is an often usedRead more

Try ultrasound for your next lumbar puncture!

“Nobody travels on the road to success without a puncture or two.” -Navjot Singh Sidhu   Ultrasound can assist in determining the best site for lumbar puncture. Here is how to do it!   1. Palpate for the superior iliac spine as you would for any lumbar puncture, and find the approximate area of L3-L4Read more

Use lower doses of ketorolac!

Ketorolac is frequently used in the ER parenterally for acute and chronic pain control. Ketorolac works as a nonsteroidal anti-inflammatory drug (NSAID). It has demonstrated analgesic efficacy similar to opiates in postoperative pain. Ketorolac is often used at doses above the analgesic ceiling of 10mg, in an attempt to achieve better pain control. The questionRead more

Fight Bites

  “Dogs never bite me. Just humans.” -Marilyn Monroe   Human bites are the third most common bite after dog and cat bites. They occur more frequently in males, typically between the late teens and in the twenties. Closed fist bites are typically caused by punching another individual in the mouth. The dorsal aspects ofRead more

The 52 in 52 Review: Tap Water for Wound Irrigation

Article Citation: Weiss EA, Oldham G, Lin M, Foster T, Quinn JV. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. BMJ Open. 2013 Jan 16;3(1). PMID: 23325896   What we already know about the topic: Traumatic wounds are a frequentRead more

Amanita Mushroom Toxicity

“You must grow like a tree, not like a mushroom.” -Janet Erskine Stuart   Amanita genus mushrooms cause a deadly toxidrome. Mortality is cited as 10-30%. The mushrooms can be identified by dots or scales on the cap. Cooking the mushrooms prior to ingestion does not significantly decrease toxicity. Amatoxin is the name given collectively toRead more

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