Crash and Burn: The Approach to the MVC Patient

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Crash and Burn: The Approach to the MVC Patient

Certain pathology gets a lot of attention in medical school.  Stroke? Sure!  Tests love asking about which vessel is blocked based on clues from the physical exam.  And rightly so; a fund of medical knowledge is certainly valuable when it comes to identifying pathology such as this.  However, when faced with a problem like blunt trauma, i.e. the “MVC”, one may find that there are also many practical and logistical factors that require bedside experience, ranging from marshaling of resources to reconciling patient presentation with reported mechanism of injury...

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Take My Breath Away! Evaluation of Shortness of Breath in the ED

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Take My Breath Away! Evaluation of Shortness of Breath in the ED

There are many chief complaints in the emergency department that can be less than satisfying (*cough* abdominal pain *cough*).  Sometimes such patients end up having a completely benign examination, no significant risk factors found on history, and an encounter that leaves you shrugging your shoulders and telling the patient “bellies will do that sometimes, we don’t always find out why.”

Of course, this is all anecdotal, but the chief complaint on this month’s episode seems to have a more consistent presence of pathology with a wide range of severity.  With such heterogeneous pathophysiology we turn to the mind of Dr. Stewart Wright to discuss the initial approach to the patient with shortness of breath (SOB)...

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Dazed and Confused: The Approach to Altered Mental Status in the ED

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Dazed and Confused: The Approach to Altered Mental Status in the ED

We will all have the experience of taking care of a patient in the emergency department who is acting…different than they normally do.  Sometimes, the change can be subtle, maybe a family member will be the first to notice and bring the patient to be evaluated.  Sometimes the patient makes the change abundantly clear.  In either case it is essential to identify the underlying cause and treat any emergent conditions precipitating this dysfunction of the brain.  This month we hear from Dr. Erin McDonough on her approach to the patient with altered mental status (AMS). 

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Feeling "Dizzy"

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Feeling "Dizzy"

This month we have the pleasure of discussing the chief complaint of “dizziness” with Dr. William Knight.  In the attached podcast much of our discussion regarding this symptom focuses on stroke as a cause of this complaint.  Even so, it is important to remember that not all patients who present to the emergency department with dizziness are experiencing a stroke.  Quite the opposite; the majority of patients seeking care for feeling “dizzy” or “lightheaded” or “imbalanced” will have a cause other than restriction of blood flow to, or bleeding into, the posterior fossa. 

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The Agitated Patient

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The Agitated Patient

I don’t know if this has happened to you yet.  It happened to me on my first shift as an intern.  I hadn’t laid hand on a stethoscope in months.  I had just unloaded the cardboard boxes from my rental truck into my new place.  As I was settling in to my first few patient encounters one of our nurses approached me to say that a patient had been brought into our area that was extremely agitated.  I looked up to see a man being held down by multiple police officers, thrashing and swearing.  

“What can I give him?” She said.

“How about a hug?” I replied.

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The Approach to the Undifferentiated Patient

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The Approach to the Undifferentiated Patient

Welcome to Bread and Butter Emergency Medicine; a back to basics, chief-complaint-based podcast series where we get a chance to pick the brains of various faculty members and residents regarding their plan of attack for a particular presenting symptom.  Imagine your first shift in the emergency department (or think back on it if you’ve been doing this for a while); a man or woman with the label of “chest pain” or “headache” or “medication refill” is sat down in front of you, staring at you through the glass of your workstation. 

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