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…
Article Citation: Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes asse…
This is a review of specific pediatric entities that may cause abdominal pain, bloody diarrhea, or vomiting. The following lists are not comprehensive and emergency physicians should consider a broad differential based on symptoms and prese…
The concept of “flow” or “being in the zone” is discussed often in sports but can extend to any activity. Being in the zone is described as an elevated yet effortless sense of concentration.1 Furthermore, it is considered to be intrinsicall…
Animal Bites (Cat, Dog, Monkey, Lizard, Snake) Quick bullets to prep for in-training, let’s review Management for ALL animal bites X-ray if suspect foreign body Remove teeth Routine wound care/irrigation Update tetanus Cats Pat…
Article Citation: Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004 Jul;…
That being said, let’s go through some commonly tested and easily confused orthopedic entities… Salter-Harris Classification Type 1 – Slipped (Physis) Type 2 – Above (metaphysis) Type 3 – Lower (Epiphysis) Type…
Clinical Scenario: A 66-year-old male with a past medical history of traumatic brain injury and frequent urinary tract infections sent from his nursing home with hypernatremia. On a routine blood draw he was found to have hypernatremia to…
Article Citation: Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, et al; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillati…
Clinical Scenario: A 28-year-old male with no significant past medical history presents with low back pain for 6 days. His pain started after playing soccer. The pain is severe, sharp, and radiates down the left leg. The pain limits his abi…
Clinical Scenario: A 2-year-old female with no significant past medical history presents with vomiting and abdominal pain for 1 day. Among other entities in your differential diagnosis you are considering intussusception, however it is lowe…
Article Citation: Moore EE, Knudson MM, Burlew CC, Inaba K, et al; WTA Study Group. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011 Feb;70(2):334-9…
Clinical Scenario: A 68-year-old man with a past medical history of diabetes mellitus, hypertension, and recent admission for pneumonia presents with fever and diarrhea for 5 days. The patient has had multiple watery stools per day. Associa…
Clinical Scenario: A 28-year-old G0P0, last menstrual period November 2, presents with amenorrhea. Urine pregnancy test is positive. Examination is normal. Bedside ultrasound demonstrates an early intrauterine pregnancy. After being given f…
