Let’s wait for the “official urinalysis”….?

Chances are you order a urine dip or urinalysis on a good number of your patients each shift. But how good are these tests at helping us diagnose a urinary tract infection? The short answer: not fantastic. Let’s continue, focusing on the “official UA”.  When looking at the UA results to determine if a patientRead more

Renal Colic & the CT scan: flip your patient prone!

A CT abd/pelvis without contrast is one of our go-to studies when evaluating for nephrolithiasis in a patient with acute flank pain. And it’s a really good one too–a recent meta-analysis of CT for suspected renal stone showed a sensitivity of 97% and a specificity of 95%. Pretty, pretty excellent. But have you ever wonderRead more

Procedure Skill: Drainage of Ischemic (Low-Flow) Priapism

Inspired by the procedural skills of Dr.’s Lazarciuc, Milliner, and Rajpal… In brief, step by-by-step: Sterile field Dorsal penile nerve block: 2 cc of Lidocaine w/o Epi injected close to penile base, from 2 and 10 o’clock aimed toward center of shaft. Insert 19-gauge needle at 2 (and if needed, 10) o’clock. Can also use butterfly connected to syringe.Read more

Urinary Tract Infection & Pregnancy

An 8 month pregnant female arrives to the ED complaining about dysuria. She is nontoxic appearing, afebrile. Exam significant for +suprapubic tenderness, -CVA tenderness. UA +leuks, +nitrates. 1) What antibiotic regimen should she be started on as an outpatient? 2) What if she had fever, +CVA tenderness, or systemic findings consistent with pyelonephritis?   Options:Read more

Abdominal Pain in a Young Male

 A 14 y/o M presents to the ED complaining of severe intermittent low abdominal pain x 2 hours. His symptoms began after he awoke from sleep to urinate, and have been unremitting since. No history of trauma. He vomited once, 20 minutes prior to arrival. His abdominal exam is benign. He appears very uncomfortable andRead more

24 year-old male, presented with multiple painful genital ulcers.  Herpes or chanchroid?  This is a question that came up during our most recent Core Didactics. Take a look at the pictures.  Which one is which? Herpes – caused by Herpes Simplex Virus  (picture on left) Presentation: Papules and vesicles on an erythematous base, erode inRead more

Pearl 12/27

A 32-year-old man presented, complaining of a painful erection for the last 18 hours. His medical history was significant for sickle cell disease,  insomnia and depression, for which he was taking quetiapine, bupropion, and prazosin. Examination revealed a mildly tender, fully erect penis and a soft glans. He was given 0.25 mg of subcutaneous terbutaline,Read more

Daily Em Pearl, 5/3/12

A middle aged man presents to the ED after almost 2days of penile pain and swelling. The sx started suddenly, during intercourse and he didn’t present until now 2/2 embarrassment.  But now the pain has not abated, the condition has not improved and he hasn’t been able to urinate. He recalls missing the introitus and theRead more

Daily Em Pearl, 5/2/12

An elderly man presents with new bloody urine x2days and abdominal distention/fullness. He noticed some clots prior to presentation and now hasn’t urinated x5hours despite a real urge to micturate. He has a h/o BPH and is on coumadin for afib. At clinic yesterday his INR was 2. On sono you appreciate a full bladderRead more

Daily Em Pearl, 4/26/12

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