Dental Infections: To Treat or Not to Treat?

/
Dental Infections: To Treat or Not to Treat?

Remember as a kid when you would come downstairs only to find your parent devouring your hard-earned Halloween candy? Consider it a favor. Though delicious, those globs of sticky sugar are a common culprit of toothaches for kids & adults alike, as well as headaches for emergency room providers. Whether in the emergency department itself, or while being cornered by a neighbor as you head out your front door, we are commonly confronted by someone holding the side of their face in agony, slowly mumbling ‘can you help me doc?’, as they wince in pain in between each word. Though our medical curriculum may not have prepared us for these moments, medicine is all about lifelong learning, so it is up to us to fill the knowledge gaps about those 32 pearly whites that are often the cause of much trouble.

Read More

A Fix for a Stinging Heart - Pericarditis Treatment in the ED

/
A Fix for a Stinging Heart - Pericarditis Treatment in the ED

Pericarditis is inflammation of the pericardial sac. Classically, pericarditis presents with sharp and pleuritic chest pain which is relieved by sitting up and forward. Pericarditis has multiple etiologies, but is most commonly idiopathic, assumed to be viral, in developed countries (1). Treatment of pericarditis should be targeted to the underlying etiology if possible (1). For presumed viral, idiopathic causes, most patients are treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine (1).

Read More

Back to Basics: Treatment of Acute Low Back Pain in the ED

/
Back to Basics: Treatment of Acute Low Back Pain in the ED

How do you treat acute low back pain that comes into the ED. Do you have a ‘cocktail’? Do you have any injections / stretching that you recommend? Is there data behind any of that?? Join Dr. Gillespie on an evidence-based look at the therapeutics of low back pain in the ED.

Read More

Swelling out of the Blue - Angioedema in the ED

/
Swelling out of the Blue - Angioedema in the ED

Angioedema is like urticaria in that both are transient swelling of well-demarcated areas. However, angioedema involves swelling of deeper tissues, producing nonpitting edema of the dermis and subcutaneous layers. It is most often seen in the eyelids and lips, and sometimes in the mouth and throat. While it is not pruritic it may be painful. In the US, angioedema accounts for approximately 100,000 ER visits annually (1). Across the world, 35% of prescriptions written for hypertension are for ACE-inhibitors (>40 million people). With a reported incidence of angioedema in 0.1–0.7% of those patients on ACEI, there are approximately 40,000 cases of ACEI-associated angioedema worldwide annually (2).

Read More

A Test of Limitations - Urine Drug Screens

/
A Test of Limitations - Urine Drug Screens

The 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 More

To Appendectomy or Not to Appendectomy: The Alvarado Score

/
To Appendectomy or Not to Appendectomy: The Alvarado Score

Appendicitis 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 More

Diagnostics: Flex your D Dimer

/
Diagnostics: Flex your D Dimer

In 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 More

Yeah, it's Pneumonia, But How Bad is it Really?

/
Yeah, it's Pneumonia, But How Bad is it Really?

According 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 More

Diagnostics: Brain MRI

/
Diagnostics: Brain MRI

If 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 More

STEMIs in Disguise

/
STEMIs in Disguise

The 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 More

Diagnostics: Musculoskeletal Ultrasound

/
Diagnostics: Musculoskeletal Ultrasound

Ultrasound 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 More

X-ray Vision - Shoulders and Elbows

/
X-ray Vision - Shoulders and Elbows

Upper 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 More