Richard Byrne, MD

Advanced Practice - My Patient Hearing Opera Singer in Right Ear

An 82 yo male presents to the ED complaining of several months of progressive hearing loss in the right ear. For the past 3 days, he can hear a male voice singing opera in the right ear only,  24/7. Read on for a brief discussion of this fascinating phenomenon and how we cured him in 5 minutes!

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Advanced Practice - Missed Orthopedic Injuries in the ED!

Check out this lateral film of the wrist. See the fracture? Look again! Surprise...there is no fracture, but this patient has sustained a serious wrist injury with the potential for long term disability. This week we highlight some of the most common missed orthopedic injuries in the ED and suggest a few strategies to minimize the errors.

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Advanced Practice: Thoracic Central Venous Obstruction!

A 25 yo male with a hx of ESRD due to membranoproliferative glomerulonephritis (MPGN) presents to the ED with complaints of swelling to his LUE, face, and neck progressive over 5 days. He was seen at another ED 2 days prior and had an ultrasound of his LUE fistula as well as a duplex of his LUE which were unremarkable.  A CT scan of the chest was ordered, revealing bilateral occluded brachiocephalic veins, which were treated in the interventional radiology suite with balloon venoplasty with resultant resolution of edema.

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Advanced Practice: ACEP Guidelines Advocate for Discharge of Low Risk Chest Pain Patients!

For decades, Emergency Medicine Providers have struggled to come to a consensus on the management of patients with chest pain with non-ischemic ECGs and negative biomarker testing. Both cardiology and emergency medicine guidelines failed to provide a clear recommendation on which patients should be discharged from the ED. The American College of Emergency Physicians has taken a bold step with their latest guidelines for the management of low risk chest pain patients which will dramatically change standard practice in the care of possible ACS patients.  

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Advanced Practice: sPESI vs Hestia Criteria for Discharge of Low Risk PE Patients

With the rise in popularity of the NOAC class of anticoagulants, more and more patients with a new diagnosis of pulmonary embolism are being discharged from the emergency department.  Multiple risk classifications tools have been developed to help identify patients at low risk of short term mortality. Read on to see if this new study determined which tool is the winner!

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Direct Measurement of Compartment Pressure Using a Stryker Device

Acute compartment syndrome is a surgical emergency.  Measurements of compartment pressures are an important adjunct to making the diagnosis. Check out this post for a video demonstration on how to operate the Stryker Device

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Advanced Practice: Duration of Prednisone Therapy for Severe Poison Ivy!

Oral steroids are a mainstay of treatment for severe posion ivy induced contact dermatitis. The doses, duration of therapy, and taper/nontaper debate has raged for decades: read on a for quick summary of a paper comparing a short steroid burst to a 15 day taper!

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Advanced Practice: High Flow Nasal Canula in Pediatrics!

You are caring for a 2 yo with multifocal pneumonia who is hypoxic on standard nasal canula. You decide to institute high flow nasal canula (HFNC) in an effort to stave off orotracheal intubation. Your repspiratory therapist requests parameters including flow rate (typically 0-40 LPM). What is the optimal flow rate to decrease work of breathing in this pediatric patient?

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Advanced Practice - Hyperleukocytosis syndrome!

A 58 yo patient with a hx of CLL presents with a chief complaint of dyspnea, wheezing, and cough for 3 days. He is noted to be tachypneic with o2 sats of 91% on RA. There is diffuse expiratory wheezing. Peripheral WBC count is 199,000, increased from a baseline of ~80,000. A CT scan shows scattered interstital infiltrates. What is going on with this patient and what is the indicated therapy?

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