Resus SinaiEM Blog – Page 70

8/27/13

Posted on August 27, 2013 by zara

A construction worker presents after spilling industrial cleaner on his hand while cleaning a brick building: What possible chemical exposure should you be concerned about? What is the treatment?

Posted on August 5, 2013 by sinaiem

How do you know if your patient’s port-a-cath can withstand power injection of CT contrast? All patients should carry a card that identifies the type of port-a-cath they have. However, many patients have lost/forgotten this card. Another option is to check the chest xray. If the port says CT on it, it’s […]

Posted on July 23, 2013 by sinaiem

76 y M p/w chest pain after using cocaine. EKG is below. What medications should be avoided in this patient? This EKG demonstrates sinus bradycardia with ST elevation in leads II, III, aVf, v3, v4, v5 and v6, suggesting inferior wall MI. Inferior MI should prompt a right sided EKG to look for right sided […]

Posted on July 22, 2013 by sinaiem

10 y F p/w right neck pain starting last night, she has decreased ROM with her head tilted to the left. This child has atlanto-axial subluxation, sometimes called Grisel syndrome. The key to identifying this condition and differentiating it from torticollis caused by muscle spasm is the relationship between head position and side of pain. […]

Posted on July 19, 2013 by sinaiem

18y M no PMH p/w 2 days of gradually worsening intermittent abdominal pain and distension. Supine abdominal film of cecal volvulus demonstrating classic “coffee bean” shape and evidence of obstruction with distended proximal bowel. Source: UpToDate, http://www.radpod.org/

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Posted on June 27, 2013 by sinaiem

Ketofol, Propofol, or Ketamine + Propofol? In a recent study published in Annuals of Emergency Medicine, Ketofol (1:1) vs. Propofol alone were studied for ED procedural sedation and analgesia. The two agents were compared for adverse respiratory events, induction time, and repeated dosing required to achieve sedation. No difference was found in all categories. In […]

Posted on June 24, 2013 by sinaiem

In ED, we often encounter patients with known HIV infection but unknown CD4 count. Any quick way to estimate the CD4 count so we can use it to guide treatment? Thanks to Dr. Jacob Isserman, who recommended a retrospective cohort study published in PubMed in 2011, which concluded that there is an association between ALC […]

Posted on June 22, 2013 by sinaiem

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 in […]

Posted on June 18, 2013 by sinaiem

A 60 yo F with sudden onset loss of vision in right eye, painless. Proceeded by a few episodes of amaurosis fugax. Physical exam: pupils appear normal on initial inspection, however afferent pupil defect noted. Fundoscopic exam: cherry red spot, pale retina, +/-boxcar segmentation (not shown in this picture). DDx for loss/reduction of vision: Glaucoma, […]

Posted on June 11, 2013 by sinaiem

55 Chinese woman, no PMH, no meds. P/w epigastric discomfort x 2 weeks, not responding to Pepcid Maalox. Presented to Elmhurst ED for worsening epigastric discomfort and generalized weakness. No fever/chill. + Mild dry cough. No chest pain. + Mild SOB with exertion. No abd pain, n/v/d/c/dysuria. No night sweats or weight loss, denied exposure to […]

Posted on May 31, 2013 by sinaiem

Which of the following deficits below the level of injury is consistent with anterior cord syndrome? Loss of total sensation and motor function Bladder and bowel incontinence and loss of motor function Loss of motor function only Loss of vibration and position sensation and motor function Loss of pain and temperature sensation and motor function […]

Posted on May 30, 2013 by sinaiem

Retrobulbar hemorrhage can result in what devastating condition? Corneal abrasion Hypopyon Central retinal artery occlusion (CRAO) Hyphema Corneal ulcer Answer: Central retinal artery occlusion (CRAO) Retrobulbar hemorrhage results from ocular trauma almost always seen with some orbital wall fracture (although not all are associated with trauma it is by far […]

Posted on May 28, 2013 by sinaiem

63 M complaining of erythema and pain to right side of his face for 3-4 days after being scratched by some metal. Right eye swollen shut with erythema and tenderness surrounding. Orbital Cellulitis v. Preseptal Cellulitis 1. Preseptal Cellulitis (also known as Periorbital) – infection of soft tissue anterior to orbital septum (DOES NOT […]

Posted on May 24, 2013 by sinaiem

Might as well finish the week off with just a bit more about suturing!!! Aftercare (what do you tell your patients!!) – Ointment (antibiotic for example) and dressing immediately after lac repair: Not much out there evidence wise what I could find indicates doing this Moisture promotes re-epithelialization Xeroform with gauze isn’t a bad idea […]

Posted on May 23, 2013 by sinaiem

Let’s keep on the suturing topic and talk technique! Interrupted suture– most commonly used in ED to close percutaneous wound Wound edges must be everted Needle enters skin @ 90 degrees with the suture loop as wide as it is deep to the skin surface Try and get similar width and depth on both sides Placed […]

8/27/13

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