Abnormal sodium values are a common finding on basic metabolic testing, however the more deranged the value, the more critical it is to think causation, as interventions to treat the abnormality can become as dangerous as the abnormality itself. Join Dr. Chhabria as she dives into the causations and treatments of dysnatremias
Read MoreHeadaches account for approximately 4 million, nearly 3% of all ED visits annually. [1] We classify headaches as either primary (benign) or secondary, with secondary headaches occurring due to underlying pathology. In the ED, the goal is to alleviate symptoms safely and effectively while excluding dangerous causes of headaches. While nearly 98% of headaches in the ED are primary or benign [2], ruling out secondary causes of headaches is imperative as failing to diagnose correctly may result in significant morbidity or mortality.
Read MoreEmergent presentations of hemophiliacs are very common, and often the degree of their need for resuscitation needs to be tailored to disease, mechanism and follow up. Join Dr. Grisoli for a just-in-time resource for managing bleeding hemophiliacs.
Read MoreNausea and vomiting accounts for one of the most frequent chief complaints we see in the emergency department. For those presenting with another complaint, N/V is often an associated symptom. Treatment of these symptoms not only improves patient satisfaction, but also decreases associated complications, like dehydration and electrolyte abnormalities.
The etiology behind a patient’s N/V is highly variable, with a broad differential that stretches across all organ systems. Although often an acute presentation, N/V is increasingly being linked to set of chronic disorders, such as gastroparesis (GP), cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS). While the work-up and initial evaluation in the ED is similar for all, specifically ruling out potentially life-threatening diagnosis or complications, the clinical presentation and management vary subtly between these syndromes.
Read MoreJoin Dr. Moulds as she dissects the difficult landscape of thrombocytopenia, where cause is king and sometimes the therapy can be more harmful than watchful waiting. Keep this one in your favorites for the next time a critical thombocytopenic patient rolls in…
Read MoreMaxillofacial trauma is common in the emergency department as ~80% of patients with polytrauma sustain injuries to the head, face, and/or neck. The most common etiologies of facial fractures are: assault (36%), motor vehicle accidents (32%), falls (18%), sports injuries (11%), occupational injuries (3%), and gunshot wounds (2%).3 The most commonly fractured facial bones are (in descending order): nasal bones, orbital floor, zygomaticomaxillary complex, maxillary sinuses, mandibular ramus, and the nasoethmoidorbital. This post will review the general approach to evaluation of maxillofacial trauma in the ED followed by specific management recommendations for various fracture patterns.
Read MoreProtein? Cell counts? Casts? The UA holds the key to the body, join Dr. Sobocinski as he decodes how to interpret the damage going on in your patient’s kidneys.
Read MoreIn 2016, a total of 16 million ED visits were reported with diabetes listed as a diagnosis, with 224,000 of these being for hyperglycemic crisis (1). In this post, we will explore the evaluation and treatment of various hyperglycemic etiologies in the ED through a series of clinical scenarios.
Read MoreOpiate Use Disorder continues to be a daily presentation with a host of complications for the patient and Emergency Provider. Dr. Jackson takes us through the latest data on how to diagnose and treat this vulnerable patient population.
Read MoreCompartment syndrome is a surgical emergency that can present after a variety of insults, ranging from those we commonly encounter in the ED (fractures, crush injuries) to more rare clinical presentations (snake bites, electrocution). The initial elevation of compartment pressures can be secondary to internal (ex. bleeding, swelling, fluid overload) and/or external (ex. compressive devices, burn eschar) factors. In this post, we detail the history/physical and diagnostic evaluation of possible compartment syndrome.
Read MoreDyspepsia and epigastric pain secondary to gastritis is a common presentation seen in the Emergency Department. Patients with dyspepsia want both quick and sustained relief of their symptoms. A thorough understanding of the evidence behind acute and long-term treatments of dyspepsia is key. In this post, Dr. Justine Milligan outlines the many treatment options available to the ED provider.
Read MoreRenal colic is a common presenting symptom in the ED, with an estimated prevalence as high as 10-15% in the US. (1) It accounts for approximately 1% of all ED visits per year. (27) Most patients will pass these calculi spontaneously and do not require surgical intervention, therefore focus on pain relief is of utmost importance in the emergency department. (1) NSAIDs have shown to be as effective, if not more effective than opioids, making them a reliable first line agent. (4,5) Opioids still provide a viable option in those with kidney disease or gastric ulcer disease, however they may be best utilized as combination agents to decrease the need for rescue analgesia. There is weak evidence to support the use of IV acetaminophen, with high cost burden, limiting its utility. Additional agents such as ketamine, lidocaine and magnesium carry with them limited evidence and inconsistencies in the literature, limiting their use, with further studies required. Alpha blockers seem to provide a shorter duration to expulsion, fewer pain episodes, and less hospital admissions with surgical intervention, specifically with larger stones (>5mm).
Read MoreAgitation? Second nature to most Emergency Physicians but an art as much of a science. The science lays the backbone of this art, however and that’s where Dr. Courtney Kein comes in. Click and join us on a dive into the literature of sedation of the agitated patient.
Read MoreOpen fractures are a common pathology seen in emergency departments, especially in trauma centers. In open fractures, the skin barrier has been compromised, exposing sterile bone to the environment. Considered a true orthopedic emergency, these fractures have high morbidity due to osteomyelitis, with infection rates up to 55%. (1) Appropriate and timely intervention in the emergency department with proper antibiotic therapy, wound care, and early orthopedic surgery involvement dramatically reduces the risk of developing osteomyelitis. In this post we will discuss antibiotic recommendations for osteomyelitis prophylaxis for open fractures. Initial management of open fractures is discussed in another post.
Read MoreOpen fractures are a common pathology seen in emergency departments, especially in trauma centers. In open fractures, the skin barrier has been compromised, exposing sterile bone to the environment. Considered a true orthopedic emergency, these fractures have high morbidity due to osteomyelitis, with infection rates up to 55%. (1) Appropriate and timely intervention in the emergency department with proper antibiotic therapy, wound care, and early orthopedic surgery involvement dramatically reduces the risk of developing osteomyelitis. In this post, we will review the management of open fractures and address additional complications from open fractures. Fractures of the axial skeleton (skull, facial bones, spine, ribs, and pelvis) will not be discussed in this post. Antibiotic recommendations for osteomyelitis prophylaxis are discussed in another post.
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.
