Elevated intraocular pressure (IOP) is a common finding among eye complaints in the ED. Dr. Melanie Yates reviews what we can do in the emergent setting to reduce the IOP with topical and systemic medications and potentially save vision.
Read MoreThe urine drug screen (UDS) is a relatively inexpensive and quick test to obtain in the emergency department, but how useful is it?. You may be tempted to order it for a patient who comes in altered or intoxicated. Before ordering, it is important to understand how the UDS works and its limitations.
Read MoreOcular Ultrasound is an increasing presence in the portfolio of specific tests within the Emergency Physicians’s toolbox of early recognition of pathology. Dr. Logan Ramsey takes a dives into the indications and evidence of ocular ultrasound
Read MoreAppendicitis is the most common surgical emergency that emergency physicians encounter each year. The prevalence of appendicitis in the US is estimated at 7%, with an incidence of 9.38 per 10,000 people annually [1,2]. Appendicitis shares many signs, symptoms, and laboratory features with other acute medical and surgical conditions, including diverticulitis, nephrolithiasis, and ovarian pathologies like tubo-ovarian abscess and ovarian torsion. Diagnostic tools such as the Alvarado score are designed to help emergency clinicians sharpen their diagnostic acumen by stratifying the likelihood of appendicitis based on scoring systems
Read MoreIn times of COVID, a Dimer of 3000 is nothing to look twice about, however there was an earlier (and future) time where the D Dimer is the hallmark of pulmonary embolism risk stratification. Dr. Comiskey breaks how how this once dichotomous tool has recent data to increase its specificity in elderly patients, pregnant patients and those with low pretest risk factors. Take a look, and when this whole pandemic is over your quiver will be fuller of Dimer tips.
Read MoreAccording to the American Thoracic Society (ATS) in 2018, 1 million patients required hospitalization for pneumonia and there were 50,000 associated deaths. Pneumonia was the leading cause of sepsis and septic shock and not surprisingly therefore qualified in the top 10 most expensive inpatient hospitalizations.(1) Given these findings, some have sought opportunity to develop mechanisms to assess and safely triage pneumonia patients to either inpatient or outpatient treatment strategies based upon pneumonia severity scores. In October 2019, the Infectious Diseases Society of America (IDSA) in conjunction with the ATS published recommendations for the assessment, treatment and disposition of immunocompetent adult patients with community acquired pneumonia which included several clinical decision rules also known as pneumonia severity scores.(2) The recommended decision rules and several associated, emerging tools are reviewed here.
Read MoreIf you have ever nodded along as someone described an MRI series weighting, you are not alone. As this modality becomes more accessible to the Emergency Physician, it is incumbent on us to familiarize ourselves with the critical aspects and critical diagnoses of MRI and how to speak the language. Dr. Zalesky takes us on a tour of the physics, indications and low-down of MRI from the ED.
Read MoreThe 2013 ACC/AHA STEMI guidelines outline, with specific age and gender-related cutoffs for ST segment elevation in certain leads. While these are clinically important, there are several STEMI equivalents or EKG patterns that do not meet these criteria but should point the practitioner to consult with an interventional cardiologist. These STEMI equivalents are found in 10-25% of cases of coronary occlusion, making it imperative that emergency personnel be familiar with these patterns.
Read MoreUltrasound continues to push into more and more of the physical exam, and nowhere is that clearer than in the musculoskeletal exam. From diagnosing and prognosticating patellar tendon ruptures and ligamentous injuries to being a procedural adjunct in shoulder dislocation to critical identification of necrotizing fasciitis, it continues to push boundaries. Dr. Broadstock gives us a look at some of the applications you need to make yourself a better practitioner in this week’s Diagnostics of Musculoskeletal US post.
Read MoreUpper extremity trauma and pain related complaints are frequently encountered in the Emergency Department. In this post, we cover the basics of the anatomy of the shoulder and elbow joint, the radiographic studies frequently performed in the evaluation of shoulder/elbow injuries, and cover some commonly encountered injuries of these joints.
Read MoreHip and knee pain almost categorically get an X-Ray in the ED, but when do you need more? And when could another view help you avoid a more costly imaging test? This week join Dr. Gressick as she gets back to the basics in the acquisition and interpretation of the hip and knee X-Rays
Read MoreSyncope is a common presenting complaint to the emergency department. Estimates suggest that 1- 3 percent of ED visits are for syncope.(1) While the large majority of these episodes are often benign, they can suggest underlying life-threatening etiologies such as arrhythmias, pulmonary embolism, and stroke. The disposition of these patients can represent a difficult quandary at times. In fact, emergency physicians are only able to establish a clear underlying diagnosis in approximately 50% of syncope patients after obtaining an HPI, physical exam and ECG. (2)
Should these patients be observed in the ED? And, if so, for how long? Should they be admitted to the hospital for further workup and observation? Should they instead be discharged home with close follow-up?
Read MoreStrep pharyngitis, commonly known as “strep throat” is a bacterial infection of the oropharynx caused by group A beta hemolytic streptococci (GAS), specifically S. pyogenes. This infection affects more than 500,000,000 people annually worldwide per year, ultimately resulting in a significant number of doctor’s visits, including to the ED (1). The classic clinical presentation of GAS pharyngitis includes sudden onset of sore throat, fever, and odynophagia. If untreated, complications of GAS pharyngitis include scarlet fever, rheumatic heart disease, post-streptococcal glomerulonephritis and peri-tonsillar abscess. In this post, we explore the diagnostic evaluation of pharyngitis with special attention to the use of the Centor criteria and rapid antigen testing.
Read MoreDizziness is common and is commonly a frustrating diagnostic dilemma in the ED. As patient’s stories vary between providers, it would be nice if we had a tool that was objective, reproducible and definitive. Enter - the HINTS exam. Join Dr. Ijaz as he discusses this nuanced exam that can change dizziness into a definitive diagnosis.
Read MoreAnion Gap in you obtunded ingestion patient? Weekend gone dry and friends digging through the back of the cabinet? Join Dr. Kimmel as she discusses the diagnostics and therapeutics in toxic alcohol injections and when in doubt, bookmark this for a quick review of their toxicities and metabolites.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
