HIV-Related Heart Disease

CAD and ACS: Both HIV and anti-retroviral medications increase patients’ risk of cardiovascular disease HIV-infected patients tend to have a first episode of ACS at age 48 yrs, 10 years earlier than HIV negative patients Reasons for increased risk include higher rates of smoking in HIV+ patients (2-3 times greater than in general population) andRead more

Differential Diagnosis of Ocular Palsies

   Abducens (CN VI) Nerve Palsy CN VI causes contraction of the lateral rectus muscle, allowing the eye to abduct. An abducens palsy will present with impairment of lateral gaze of the affected eye. Causes of an Abducens palsy include: Vasculopathic (DM, HTN) Traumatic Meningeal or parameningeal infections Idiopathic Giant cell arteritis Brainstem lesions (mostRead more

Ovarian Torsion: Literature Review and Predictive Signs

A recent systematic review in Pediatric Emergency Care attempted to identify the most reliable clinical, biological, and radiological signs of ovarian torsion in the pediatric population. Ovarian torsion is a rare but serious cause of abdominal pain in pediatric patients with an incidence of 0.5-2 per 10,000 patients. Delay in diagnosis correlates with decreased rateRead more

Therapies for Beta Blocker Overdose

A 42 yr old male is BIBEMS by his friend after reportedly ingesting an unknown amount of metoprolol 5 hours prior to arrival. In the ED he is hypotensive to 80s, bradycardic to 40s, with decreased mental status. The patient is intubated, a percutaneous sheath introducer is placed and he receives two liters of fluids,Read more

Easily missed upper extremity fractures

An uncommon fracture can be easy to miss, and if you do not look for it, you might not see it. Scapula fractures – Typically seen in association with other injuries in setting of major trauma, but may be missed in the patient with shoulder pain 2/2 lower impact trauma. Most isolated scapular fractures canRead more

Risk factors for mortality in blunt chest wall trauma

In patients with not immediately life-threatening blunt chest wall trauma, it can be difficult to decide which patients may require hospitalization and which patients can safely return home. A systematic review assessing risk factors for mortality in blunt chest wall trauma patients defined blunt chest wall trauma as “blunt chest injury resulting in chest wallRead more

Why is there a terminal R in aVR with TCA poisoning?

The terminal R in AVR can be seen with any significant ingestion of a sodium channel blocking agent (including TCAs). Sodium channel blocking agents work by delaying phase 0 (upward stroke) of the myocardial action potential. This leads to changes in QRS morphology and duration. The right-sided intraventricular conduction system is more vulnerable to toxicRead more

Cervical artery dissections in the ED

Cervical artery dissections include carotid or vertebral artery dissections and can be seen in patients of all ages, although they are a more common cause of stroke in young patients   Symptoms may be somewhat non-specific (headache, neck pain, dizziness) or can be more localized (partial Horner syndrome with carotid artery dissection, etc.)   MinorRead more

An unusual rash

A 19 yr old male with a history of depression presents to the ED with diffuse, worsening rash, arthralgias and fever for the past 2 days. The patient recently started taking bupropion over the past 3 weeks and also started venlafaxine last week. He notes that the rash began as pruritic hives over his bodyRead more

Emergencies in Patients with Rheumatologic Disorders

Patients with connective tissue diseases and vasculitides can present to the ED with vague or seemingly innocuous complaints but may actually have a life threatening condition. Key conditions to assess for include: 1. Septic arthritis in the rheumatoid arthritis (RA) patient Can be difficult to diagnose, especially in the earlier stages of infection, where anRead more