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.
Richard Byrne, MD
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.
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.
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!
Treatment of diabetic ketoacidosis in the emergency department includes aggressive volume repletion and administration of insulin, however it is also extremely important to address electrolyte abnormalities…
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
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!
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?
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?
- A 50 yo male presents with severe fatigue, tactile temps, chills, fatigue, and dizziness for one week. The family also notes yellowing of his skin. T is 102.3 oral. His labs demonstrate a Hgb of 8.8, platelets of 141, and TBili of 1.6 with a normal direct bili. Cr is noted to be elevated at 1.42 with a normal baseline. What is going on with this patient and whom should we call?