Approach to Hernias in the ED

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Approach to Hernias in the ED

A hernia is described as, “the abnormal protrusion of abdominal contents through a defect involving the normal confines of the abdominal compartments” (9). It often involves a portion of the intestine protruding through a weak point of the abdominal wall. The location and size of the hernia often determines the symptoms and complications that a patient will present with.

There are several risk factors that make developing a hernia more likely. Older patients and those who have had prior abdominal surgery may have weaker abdominal muscles or connective tissue which would make it easier for a hernia to develop. In addition, if there is increased abdominal pressure, such as patients with obesity, or those who participate frequently in weightlifting, this is another factor that may put someone at a higher risk of developing a hernia. Finally, those with poor wound healing, such as people who smoke often or patients with diabetes, may be at risk for incisional hernias. (6)

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Diagnostics and Therapeutics: Tricks of the Trach

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Diagnostics and Therapeutics: Tricks of the Trach

Successful airway management is one of the cornerstones of every emergency medicine physician’s toolkit, and tracheostomies can often fall under that category of “difficult” or “scary”. In this post, we aim to familiarize learners with the anatomy of the trach airway and basics of trach tubes as well as teach management and troubleshooting of various complications of tracheostomies.

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Diagnostics and Therapeutics: The Who, What, Where, When and Why of Lumbar Punctures

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Diagnostics and Therapeutics: The Who, What, Where, When and Why of Lumbar Punctures

Lumbar punctures can be a high stress and difficult procedure for many. Dr. Knudsen-Robbins walks us through the optimal setup, performance, and troubleshooting of this procedure, including the ultrasound-assisted LP! Check out this article before your next LP attempt to breeze through this procedure with ease.

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Diagnostics and Therapeutics: Vascular Access in the Emergency Department

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Diagnostics and Therapeutics: Vascular Access in the Emergency Department

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. However, in at least 10% of patients, blind insertion of a peripheral IV may be unsuccessful for a variety of reasons. In this post, we will review multiple alternative access options, as well as briefly discuss concerns related to PICC lines.

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Troublesome G-Tubes

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Troublesome G-Tubes

Replacing gastrostomy tubes that have fallen out or are no longer functioning is a common procedure in the Emergency Department. Often, these replacements are smooth and easy. There are times however when the replacement process can get complicated with the need to dilate quickly stenosing tracts and/or the need to consult a sub specialist to assist with replacement. This post covers the key historical factors to gather on these patients and the basics steps in replacing the tubes.

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Troubleshooting Foley Caths and Suprapubic Caths

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Troubleshooting Foley Caths and Suprapubic Caths

Placement of a foley catheter is usually a simple process. However when it doesn’t go smoothly, when the foley just won’t seem to pass, there are specific approaches that are needed to successfully catheterize the patient. Suprapubic catheters will also frequently need replacement and troubleshooting in the ED.

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Diagnostics and Therapeutics: Ear Emergencies in the Department

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Diagnostics and Therapeutics: Ear Emergencies in the Department

Ear trauma, pain, and infection are a few of the common presenting complaints in emergency departments across the US, accounting for millions of visits annually. This post aims to review the diagnosis and treatment approaches for common ear emergencies including auricular hematomas, outer ear infections, and retained foreign bodies.

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Diagnostics and Therapeutics: Managing Pneumothorax

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Diagnostics and Therapeutics: Managing Pneumothorax

There are many different types of pneumothorax (PTX), and the management paradigm has shifted in recent years as the research has exploded on this topic. This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Institutional resources and specialty services may further dictate the management of PTX. This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department.

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Riding the Waves: End-Tidal CO2 Monitoring

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Riding the Waves: End-Tidal CO2 Monitoring

End-Tidal CO2 monitoring has a variety of uses in the Emergency Department.  Whether used diagnostically or for monitoring of a patient’s physiology, clinicians must possess an understanding of the information that you can gather from EtCO2 waveform tracings. Knowing how to interpret the waveforms makes EtCO2 much more than a number, allowing the clinician to gain insight into minute to minute changes in a patients physiological state.

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Foot Injuries in the ED

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Foot Injuries in the ED

As an EM physician, it is important to have an understanding of the spectrum of foot injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive. Injuries discussed are shown in Image 1.

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Twisting and Turning - Ankle Injuries in the ED

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Twisting and Turning - Ankle Injuries in the ED

As an EM physician, it is important to have an understanding of the spectrum of ankle injuries and how these are appropriately evaluated. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. This post will cover some of the most common and important injuries, but is not comprehensive.

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Fearsome Foliage - An Overview of Toxic Plants

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Fearsome Foliage - An Overview of Toxic Plants

Spring has sprung... and so have many species of toxic plants! Poison centers across the United States receive over 100,000 reports of exposures to toxic plants annually. It is often difficult for Emergency Medicine providers to determine the quantity and time of exposure. Plant identification presents another challenge, and can even require the input of a botanist. Now that is an interesting consult! Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized in this post.

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