As ER doctors, we stick a lot of needles into a lot of different body parts. Sometimes into vessels, sometimes into the area around the spinal cord, and of course, sometimes into hot, swollen joints. The ankle is included in this which can often prove difficult to access. To help you through your next angry ankle, here are a couple of pointers.
Incorporating Diagnostic Testing Into Your Clinical Decisions
Understanding the mathematical breakdown of how we incorporate testing into our medical decisions is tough. This post will provide you with some structure and understanding into the processes behind the decisions you make and the tests you order.
The Best Agent For Digital Nerve Blocks
Explore the evidence behind previously held beliefs regarding local anesthetic use in digital nerve blocks.
Quick Guide to Minor Facial Trauma: Part I
In the emergency department, we commonly encounter minor injuries to the face and mouth. In a two part series, we will provide a short overview of some helpful strategies for dealing with these cosmetically sensitive injuries in an effective manner.
Ovarian Hyperstimulation: Not Your Ovarian Average Cyst
Pregnancies resulting from assisted reproduction are more complicated, with higher rates of ectopic, heterotopic and multifetal pregnancies, in addition to higher rates of abortions and premature deliveries. Other complications include venous thromboembolism as well as ovarian hyperstimulation syndrome. These are high risk pregnancies that will present to your emergency department and you should be aware of key management principles.
Complications of Central Venous Catheters
We review the recent randomized-controlled trial by Parienti et al in the New England Journal of Medicine which sought to determine the complication rate of central venous catheters (CVC) at the 3 primary sites of insertion.
Transfusion Reactions In The ED
Blood products, despite what may be commonly believed, are a scarce and valuable resource. While overall, there are many systems to ensure the safety of the products, any transfusion poses a certain degree of risk. We review the spectrum of transfusion reactions, from the common to the uncommon.
Wet, Wacky Lungs: A Quick Look At Pleural Effusions
According to the National Cancer Institute, there are 100,000 pleural effusions diagnosed every year. Read on to optimize your management of this very common ED presentation and know whether or not you should "tap that."
The New And Improved Valsalva: The Revert Trial
Consider upgrading your Valsalva manoeuvre for supraventricular tachycardia. Don't believe it will work? Read our analysis of the REVERT trial for yourself and let us know what you think!
Journal Club: Coronary CT Angiography Versus Traditional Care
Coronary CT Angiography (CCTA) has shown promise in three major randomized controlled trials evaluating its safety in risk-stratifying low- to intermediate-risk patients. Additionally, CCTA-based screening was shown to increase rate of discharge directly from the ED, and decreased length of stay. The study discussed in this Journal Club Review contributes to the growing body of evidence regarding use of CCTA and its role in screening patients with lower risk chest pain.
Acute Retroviral Syndrome In The ED
Consider acute retroviral syndrome like endocarditis or meningitis or epidural abscess: another life threatening cause of a seemingly benign febrile illness that we must recognize. HIV infection, especially in its primary phase, represents a life threatening malady that could have serious implications on the patient and the public health at large if not diagnosed.
Myocarditis in the ED
Myocarditis is an inflammatory change of the heart muscle and an important differential diagnosis for patients presenting with non-specific symptoms such as low grade fever, fatigue, malaise, dyspnea on exertion, palpitations, and/or chest pain in the ED.
Color Coded Clarity
The American Academy of Ophthalmology (AAO) has been attempting to reduce errors in ophthalmic drops since the mid-90’s with the advocacy of a uniform color coded system for topical ocular medications. This standardized color system would then theoretically help patients and providers identify medications correctly and reduce errors both inpatient and outpatient.
Journal Club: Immediate Discharge Home of Newly Diagnosed VTE
Clinical Question: Can low-risk patients with a newly diagnosed VTE in the ED be safely discharged home?
Beta Blocker Toxicity
Beta-blockers are the fifth most commonly prescribed medication in US and are frequently involved in potentially fatal single or multi-drug ingestions. Cardiovascular drugs as a whole are the 2nd most common culprit of adult death from all overdoses.
The Silent Killer: A life-threatening diagnosis missed by 7 out of 8 ED physicians
Inter-personal violence (IPV) is a life-threatening diagnosis missed by 7 out of 8 ED physicians. This short discourse on IPV can help you to be more prepared to both diagnose and treat a patient whom you may be concerned is experiencing this silent killer.
Risk Analysis of Pulmonary Embolism by CT Imaging
In CT imaging for acute pulmonary embolism, what can we infer from a radiologist’s comments about the right heart in terms of risk stratification and management?
Journal Club: Ketamine Versus Morphine for Pain Control
Ketamine has recently gained popularity amongst emergency physicians, and discussions about its efficacy and safety continue to shape practice in emergency medicine. Specifically in this post we will look at a recent article regarding sub-dissociative Ketamine for acute pain management in the emergency department.
The Achy Breaky Heart
In 1990, only two years before singer Billy Ray Cyrus revealed his cardiac myocytes to be “achy breaky”, Japanese scientists first described a pathophysiologic mechanism for a common condition which has, for centuries, plagued philosophers and poets, cardiologists and lyricists alike: the broken heart.
The Rash Worth A Midnight Phone Call
It is not often that we have to call our dermatology colleagues in the middle of the night. Here we present a rash worthy of a midnight phone call filled with both core content and clinical pearls.