You have made the diagnosis of disseminated gonococcal infection in your patient presenting with history and physical exam findings suggestive of purulent arthritis, now what? Treatment for gonococcal arthritis goes beyond the one-time "shot and a pill" given for uncomplicataed gonococcal infections. A quick review of disseminated gonococcal infection:
Patella fractures represent 1% of all fractures and are commonly seen after direct trauma to the bone (fall onto flexed knee, "dashboard" injury"). When to involve your consulting orthopedic surgeon is a key branch point in the management and care of these patients.
Beyond mortality, the plague of bacterial meningitis on the body and central nervous system has been well described. Included in post-meningitis neurologic sequelae are sensorineural hearing loss, seizures, and focal neurologic deficits. Early administration of dexamethasone serves to reduce CNS cytokine production and limit the severe inflammation contributing to the development of these long-lasting neurologic effects. Furthermore, appropriate timing and dosing of dexamethasone therapy in these patients is crucial and can be easily overlooked.
The mild, moderate, or severe asthma exacerbation is cemented in the practice of Emergency Medicine. As a provider of this great speciality, one should be intimately familiar with the range of therapies employed. The goal of this post is to provide a high-yield review of the therapies we use (or sometimes use) while treating these patients.
The acute medical management of an upper GI bleed from peptic ulcer bleeding includes both hallmark and emerging medical therapies with which any Emergency Physician should be intimately familiar. Many of these therapies are adopted recommendations from our Gastroenterology colleagues who ultimately perform emergent/non-emergent endoscopy on these patients. To understand why Gastroenterologists think the way they do, here is a review of these specific therapies along with the evidence behind them.
The rare diagnosis of thyroid storm can be difficult to distinguish between thyrotoxicosis. Use the Burch-Wartofsky scoring system to help identify patients with thyroid storm! A score >45 is highly suggestive of thyroid storm.
25-35% of patients with chronic liver disease with experience variceal bleeding. This post is designed to provide high-yield pearls in the evaluation and acute management of variceal bleeding.
Ankle sprains are one of the most common traumatic injuries encountered in the Emergency Department. The pathophysiology of an ankle sprain occurs when there is abnormal movement of the talus within the ankle mortise leading to disruption of the surrounding ligaments.
Excited delirium syndrome is a pathophysiologic progression that Emergency Medicine physicians are exposed to daily. While the initial management often takes place in the pre-hospital setting, these patients are at high risk of respiratory and cardiac arrest if proper management is not continued after hitting our doors. Despite a growing awareness of excited delirium syndrome and it's associated increased risk of death, the majority of the 250 annual deaths from this entity occur while in police custody.