Knee dislocations are a dangerous and easily missed diagnosis.  Morbidity is high as 20% have a serious vascular injury, many of which lead to amputation.  This can occur with even ground levels falls in elderly and obese patients, so a high index of suspicion is warranted. What kind of dislocation? These are tibiofemoral dislocations, not patellofemoral […]

For the very few things they actually do, babies can be very complicated. Breathing irregularities especially can pose a challenge to providers. Knowing the difference between a benign and a dangerous cause for apnea/cyanosis/loss of muscle tone or choking is difficult and underlies the diagnosis of BRUE. BRUE (brief, resolved, unexplained event) usually occurs in […]

Heat stroke is classified as temps >40.6C with neurological dysfunction and is secondary to a failure in ones thermoregulatory system.  It is classically non-exertional and seen in elderly patients during a heat wave or being in a van on a hot day. Can also occur from physical activity like with young football players in hot […]

Abscesses are already painful and can cause scars, so why don’t we try a cool move to minimize this for patients?  Loop drainage has come to the forefront due to lower failure rates, less scaring, continuous draining, and no need for packing/repacking! How is it done?  (https://www.youtube.com/watch?v=hkEidzzs0JY) 1. Numb the abscess with lidocaine +/- epi […]

Sometimes the most serious oncologic emergencies present very benignly: a slow nose bleed (portending DIC), a low grade fever (neutropenic bacteremia), vague weakness/fatigue (an undiagnosed leukemia)… The triage nurse calls you out to triage to evaluate a patient as the resus resident. He is concerned because the patient is complaining of “I can’t walk straight,” […]

32-year-old, “otherwise healthy,” man with severe, sharp, epigastric abdominal pain. Your differential is broad enough, but you target a few questions: Drinker? (No.) Gastritis/GERD/PUD in the past? (No.) Gallstones? (No.) Smoker/Hypertensive/your-aorta-or-mesenterics-are-in-trouble? (No.) Bitten by a scorpion lately? (No.) Jokes aside, you’re thorough. He has had terrible, worsening, constant pain for the last 2-3 days. No […]

It’s summer. Drowning is a tragedy that kills about half-million people each year worldwide, and is the second leading cause of traumatic death among children age 1 to 4 in the United States. Death from drowning (i.e. respiratory failure secondary to submersion/immersion in a liquid) occurs acutely secondary to hypoxia, laryngospasm, and aspiration. If surviving […]

An intake / peds / fast-track chief complaint with an almost certain procedure: ingrown toenail. To state what may be obvious, this occurs when the distal portion of the nail has improperly grown into the lateral nail folds. It causes inflammation, pain, and often a paronychia, too. It can be caused by poorly fitting (tight) shoes, […]

As promised, another EMS-related post. Imagine yourself the first to arrive on the scene of a bus accident when you’re driving on your next road-trip vacation. Patients (limp, crawling, walking) are strewn about the street next to the over-turned vehicle, and you can see another dozen or so more people inside–some moving, some screaming, others […]