Richard Byrne, MD

Critical Cases: Not Just an Ankle Sprain! Demystifying the Maisonneuve Fracture

Independently interpreting plain film imaging is an essential skill for the Emergency Medicine provider. Among the most notorious of injuries likely to be missed is the Maisonneuve fracture. In this post we demonstrate the "can't miss" imaging findings to ensure that you don't make the mistake of thinking this is "just an ankle sprain!"

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Critical Cases - Epidural Abscess Emergency!

A 61 yo male presents to the ED for the second time with complaints of back pain. While the overwhelming majority of cases of back pain are benign, there are a few "can't miss" causes which will result in paralysis if not diagnosed early. You ponder these diagnoses as you make your way to the patient's room...

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Critical Cases - Blunt Myocardial Injury

Blunt chest injury can rarely result in a direct contusion to the myocardium. This "bruise of the heart" can precipiate lethal cardiac arrhythmia, often in a delayed fashion. As you evaluate a trauma patient with complaints of chest pain after blunt injury,  you wonder what the correct workup and management of this potentially fatal condition should consist of....

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Critical Cases - Blunt Myocardial Injury

Blunt chest injury can rarely result in a direct contusion to the myocardium. This "bruise of the heart" can precipiate lethal cardiac arrhythmia, often in a delayed fashion. As you evaluate a trauma patient with complaints of chest pain after blunt injury, yo you wonder what the correct workup and management of this potentially fatal condition should consist of....

Critical Cases - Post LP Subdural Hematoma!

A 24 year old female presents to the ED complaining of a worsening headache after a lumbar puncture performed in the ED 2 days prior which diagnosed idiopathic intracranial hypertension. "No problem!" you think. Either this is just a post LP headache or possibly the patient needs more CSF drained to improve her headache. LP is a very safe procedure with minimal risk after all! Right?

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Critical Cases - Serious Headaches and Where to Find Them

Most patients presenting to the ED with a headache have a simple primary headache: tension, migraine, or cluster. Detecting the "other" etiolgies for headache, which can result in neurologic devastation or death, is often a diagnostic challenge. He we give some quick hits for one of the "can't miss" headaches, how it presents, and how to diagnose it.

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Critical Cases - Back pain bounceback!

A 55 year old male presents to the ED with complaints of anterior chest pain radiating through to the thoracic area X 2 days...you mentally run through a check list of the potential "red flag" signs/symptoms for serious back pain before you enter the room. Will this be another benign musculoskeletal pain or something more sinister?

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Critical Cases - "I drank this"

A 50 yo male is brought in via EMS vomiting red fluid. 1 hour prior, he had chugged about half a gatorade bottle that he had used to store windshield washer fluid. "What's in windshield washer fluid?" you wonder as you enter the patient's room. "Is it bad????" Read on to find out why, yes, this is very bad indeed.

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