Richard Byrne, MD

Critical Cases - Back pain emergency!

The overwhelming majority of patients with back pain have a benign etiology and require nothing more than pain control and time to recover fully. A good emergency medicine physician, however, should always keep in mind the "can't miss" diagnoses and take a careful history focusing on "red flag" symptoms and risk factors. Failure to make the diagnosis in our patient today would result in irreversable paraparesis, incontinence, and impotence. Read on to see why!

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Critical Cases - Tension Pneumothorax!

A 76 yo female with a history of Stage IV breast Ca with metastasis to the lung presents to the ED with acute shortness of breath 10 hours after an outpatient placement of a right sided PleurX chest tube for drainage of recurrent malignant effusion......

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Critical Cases - Locked knee!

A healthy 23 yo male presents after injuring his knee playing soccer. He is complaining of inability to completely extend his knee. "It's stuck." he reports to the triage nurse. "That seems like a problem..." you think to yourself as you enter the room. How did this happen? How do I unstick his knee? Read on for some quick pearls on the "locked knee."

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Critical Cases: Tips for a Perfect Reduction

Do you feel like you pour your heart, soul, blood, sweat, and tears into your fracture/reductions and still come up short? Does the orthopedics consultant always want to "re-do" your attempt? Here is a repost of a podcast interview between former Cooper EM resident Patrick Sheehan, former Cooper Orthopedics Resident Joseph Legatol on how to get a perfect reduction. Inside the interview are 5 tips on positioning yourself for success. Also included is a video of Dr. Sheehan giving an example of "exaggerating the injury" of a distal radius fracture for a more successful reduction. 

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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....

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