Happy Turkey Day We’ve all seen the patient who comes in complaining of chest pain with a left bundle branch block pattern (LBBB). Many times we don’t have an old EKG to compare. Just as a review, a LBBB presents difficulty since it will alter early and late ventricular depolarization to produce secondary ST-T segment […]
A 4-year-old boy comes to the ED with a severe sore throat and history of “refusing to eat”. He has severe pharyngitis on exam an you are concerned that he may have a retro pharyngeal abscess. What technique should be used to most accurately assess the prevertebral space on lateral neck X-ray? To avoid […]
Buckyballs are extreme magnets marketed to adults. There have been several case reports of intestinal perforation following ingestion of multiple balls. The magnets stick together through intestinal wall resulting in perforation. Ingestion is considered a surgical emergency. You can see the magnets and confirm their presence on X-ray. Brought to you by Dr. Schiappa
If you see a patient who has been involved in a physical altercation make sure to check their hands for signs of abrasions/lacerations as these may represent “fight bites”. If you seen any damage to the skin you should treat the patient just as you would anyone you saw with a bite wound. Tetanus, wound […]
A prior post discussed the optimal imaging angle for 2D scanning. Quick quiz: what is that angle? 45 degrees 90 degrees 180 degrees 360 degrees In this post we’ll illustrate the optimal imaging angle for Doppler evaluation. Let’s start with basic Doppler physics. Where to police officers situate themselves to aim a radar gun at […]
Impetigo is a type of bacterial rash normally occuring on the face and extremities that progresses from papules to vesicles to pustules then crusts. There are two main sub types of impetigo: non-bullous and bullous (caused by S. aureus that produces exfoliative toxin A). The organisms that cause the rash are S. aureus and streptococci species. […]
Is ultrasound the stethoscope of the future? Is it an extension of the physical examination? Will it replace the physical exam? No. Point-of-care ultrasound is a diagnostic test. It is a rapid, bedside, noninvasive, accurate, diagnostic test, but still a diagnostic test. It can certainly augment data obtained through physical examination and medical interviews, and […]
Temporary cardiac pacing: electrical stimulation to heart to treat tachyarrhythmia or bradyarrhythmia Transcutaneous: pacing through the skin Complications: significant pain (requires sedation), decreased reliability Transvenous: Insert through left subclavian vein or the right internal jugular vein. In the ED, we generally only use ventricular pacing but it is possible to also pace from the atrium […]
Pericardial effusion – accomulation of fluid within the pericardium Causes of effusion infection: viral, bacterial, TB, fungal – viral, purulent, TB drugs and toxins autoimmune disease metabolic disorders – uremia, dialysis, hypothyroid collagen vascular diseases neoplasitc – lung and breast cancer, Hodgkin lymphoma, mesothelioma degenerative trauma radiation iatrogenic – post surgery Post MI aortic dissection […]
Dengue fever Epidemiology: ~ 50 million cases per year, mosquito vector disease Disease syndrome has clinical variability from asymptomatic infection to dengue hemorrhagic fever with shock syndrome Incubation period — ranges from 3 to 14 days Symptoms: fever with marked muscle and joint bains (“break-bone fever”) often followed by fatigue, can also have non-specific rash […]
