Packers, Stuffers, and Pushers

Packers, Stuffers, and Pushers

Body packers, stuffers, and pushers may present to the emergency department (ED) for evaluation of symptoms or for medical clearance before prosecution. It is important for the ED physician to have a keen framework for diagnosing, evaluating, and treating these patients.

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Do You Hear What I Hear: Tinnitus and Auditory Disturbances

Do You Hear What I Hear: Tinnitus and Auditory Disturbances

The majority of cases of hearing loss and tinnitus are not immediately dangerous and may be safely deferred to the outpatient setting. There are, however, several etiologies of such complaints that are dangerous and require prompt evaluation in the emergency department. The approach to hearing loss and/or tinnitus in the emergency department must focus on identifying characteristics that may clue the examiner in on a potentially harmful etiology.

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Lymphedema and Its Mimics

Lymphedema and Its Mimics

Lymphedema is a progressive pathologic condition of the lymphatic system where interstitial accumulation of protein-rich fluid leads to subsequent inflammation, adipose tissue hypertrophy, and fibrosis [1]. The direct effect of this development and its long-term complications can lead to disfigurement, decreased mobility, and significant morbidity. While the management of lymphedema typically requires long-term therapeutic interventions outside of the role of the Emergency Department, a thorough understanding of this condition and its mimics will help Emergency Physicians appropriately evaluate and manage the broad presentation of “swelling”.

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Diagnostics: Dysnatremias

Diagnostics: Dysnatremias

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

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Atypical Headaches

Atypical Headaches

Headaches 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.

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All that Pukes: Cyclic Vomiting Syndrome, Gastroparesis and More

All that Pukes: Cyclic Vomiting Syndrome, Gastroparesis and More

Nausea 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.

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Therapeutics: Platelet Coagulopathy Fixes with ITP, TTP and DIC

Therapeutics: Platelet Coagulopathy Fixes with ITP, TTP and DIC

Join 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…

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Face the Music: Emergency Management of Facial Fractures

Face the Music: Emergency Management of Facial Fractures

Maxillofacial 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.

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Hyperglycemia in the ED

Hyperglycemia in the ED

In 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.

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