Author: Mark Kozlowski M.D. Educational Pearls: Humans cannot "multitask" effectively - a more accurate term is "task interruption." When doing more than one task at once, we are more likely to forget key details and perform both tasks more slowly overall. Do not interrupt people who are focusing on critical tasks - programming a pump or drawing up doses. Think about ways to reduce task interruption in your hospital for a better clinical practice. References: Westbrook JI, Woods A, Rob MI, Dunsm...
May 08, 2017•4 min
Author: Don Stader M.D. Educational Pearls: Non-traumatic back pain is a very common complaint in the Emergency Department. Conditions that can manifest with back pain include: ruptured abdominal aortic aneurysm, retroperitoneal bleeding, cauda equina syndrome, epidural abscess or cancer. Patients with cauda equina syndrome or epidural abscess prefer to sit forward, while people with disc issues tend to sit upright. References: https://emergencymedicinecases.com/episode-26-low-back-pain-emergenc...
May 06, 2017•3 min
Author: Arthur Lessen M.D. Educational Pearls: Zofran (ondansetron) is generally safe to use for the treatment of nausea and vomiting. However, it can prolong the QT interval and increase the chance for torsades. Low doses of Zofran are not likely to be an issue. However, when multiple doses are given, especially in the setting of a preexisting LQTS, clinical concern should be raised. When giving Zofran to a patient with an increased risk for torsades, consider continuous cardiac monitoring or a...
May 04, 2017•3 min
Author: Aaron Lessen M.D. Educational Pearls: Imodium (loperamide) is a mu-opioid receptor agonist. Traditionally, it is used as an anti-diarrheal. It is also abused recreationally for an opioid high and to self-treat opioid withdrawal. 40 or more pills are often ingested. People often co-ingest with cimetidine to potentiate the desired effects. Patients will present with opioid overdose symptoms (narrow pupils, respiratory depression). Narcan is effective in reversing an overdose of Imodium. Im...
May 02, 2017•3 min
Author: Dylan Luyten M.D. Educational Pearls: Ashman's Phenomenon occurs in the setting atrial fibrillation and mimics ventricular tachycardia, but is harmless. On ECG, the pattern of Ashman Phenomenon is a long cycle, followed a short cycle, followed by a complex wide complex beat. The wide complex beats have right BBB morphology. The long R-R followed by a short R-R leads to conduction down the left bundle branch while the right bundle branch is still in a refractory period. References: https:...
Apr 30, 2017•2 min
Author: Samuel Killian M.D. Educational Pearls: Lower extremity DVTs are extremely common. There are more left lower extremity DVT due to anatomical variation. May-Thurner Syndrome is a form of anatomical variation in which the left iliac artery compresses the left iliac vein. Anticoagulation may not be sufficient to treat those with May-Thurner syndrome - endovascular stenting may be needed Patients with with recurrent LLE DVT, especially those in whom anticoagulation fails, should be referred ...
Apr 28, 2017•3 min
Author: Don Stader, M.D Educational Pearls: It is important for providers to know how to use IV drugs properly so that they can instruct their patients on how to avoid injury. Heroin use is increasing. Hepatitis, HIV and infection are possible complications of improper IV drug use The first step of heroin use is to dissolve the solid heroin in water using heat - a spoon and lighter are often used for this step. Next, the heroin is drawn into the syringe through a filter (cotton is often used). H...
Apr 26, 2017•7 min
Author: Peter Bakes, M.D Educational Pearls Intracerebral hemorrhage is an intracranial bleed within the brain tissue or ventricles. Subarachnoid aneurysm causes about 50% of all ICH. Amyloid deposition can lead to ICH in elderly patients. Hypertension is another common cause of atraumatic ICH, commonly leading to pontine, cerebellar, or basal ganglial bleeding. Bleeding in other locations is suggestive of a different etiology. ICH will often present with depressed mental status, but specificall...
Apr 24, 2017•10 min
Author: JP Brewer M.D. Educational Pearls: The "Quick Wee" was a method to get urine out of infants who need to have a UA in the Emergency Department. A randomized-controlled experiment was done with 350 infants between the ages of 1 to 12 months. The "Quick Wee" method is taking a sterile saline gauze with cool saline and rubbing it over the suprapubic abdomen for five minutes. The results were significant, with 31% in the treatment group voided after five minutes, 12% in the control group void...
Apr 22, 2017•2 min
Author: Jared Scott M.D. Educational Pearls: There are two anatomical triangles on the back, the inferior lumbar triangle and the superior lumbar triangle. Herniation occurs whenever something moves to a place where it is not supposed to be, often through a fascial weakness. A "back hernia" can happen when the contents of of the abdominal cavity herniate into the back, usually through the superior lumbar triangle. This is also known as a Grynfeltt-Lesshaft hernia. Back hernias can be traumatic o...
Apr 20, 2017•3 min
Author: Chris Holmes M.D. Educational Pearls: Mechanism of injury involves hyperextension/hyperflexion Pathophysiology: inside of the arteries in the neck becomes disrupted, similar to a dissection. This is thrombogenic and leads to cerebral infarction Neurologic deficit is common. Other risk factors include facial fracture and cervical-spine fracture. Treat with anticoagulation - aspirin or other antiplatelet agents are appropriate. Increase clinical suspicion when patient presents with neurolo...
Apr 18, 2017•3 min
Author: Michael Hunt M.D. Dr. Hunt shares his wealth of experience with biological terrorism over the course of his career.
Apr 16, 2017•28 min
Author: Rachel Duncan, PharmD BCPS Educational Pearls: Toradol (Ketorolac) is an NSAID used for its anti-inflammatory properties In practice, the common dosages are 30mg IV or 60mg IM. Clinical concerns arise in patients with renal insufficiency or bleeding, but the risks are small ( Studies have found that doses over 7.5mg have the same efficacy in pain control as higher doses. Consider lower-dose Toradol (15mg) and decrease dose in the elderly and those with a CrCl References: Motov S, Yasavol...
Apr 14, 2017•2 min
Author: Donald Stader M.D. Educational Pearls: Coffee originates from Ethiopia. Its "active ingredient" is caffeine. Caffeine is a xanthine alkaloid used in medicine to control headache and as a neonatal stimulant. Studies have shown that coffee may increase lifespan. Overdose can be encountered in those using diet pills or concentrated caffeine pills and is treated with dialysis. References: Juliano, LM et al. "A critical review of caffeine withdrawal: empirical validation of symptoms and signs...
Apr 12, 2017•4 min
Author: Peter Bakes M.D. Educational Pearls: Some common causes of monoarticular arthritis include: crystal arthropathies (gout and pseudogout), infection (septic joint), reactive arthritis and acute presentations of chronic arthritides. Lyme disease usually presents with a targetoid lesion associated with constitutional symptoms. The common triad of symptoms associated with reactive arthritis (aka Reiter's Syndrome) consists of conjunctivitis, urethritis, and arthritis. Reactive arthritis commo...
Apr 10, 2017•6 min
Author: Gretchen Hinson M.D. Educational Pearls: The key imaging of a mumps patient is "chipmunk cheeks" or parotitis. The swelling can extend almost to the ears and can be extremely painful - in about 25% of cases the swelling is unilateral. Other organs can be involved as well including: testicles, ovaries, breast tissue, other salivary glands, and the brain/spinal cord. Mumps is transmitted through droplets in the air. Two immunizations will get you 88% probability immunity and one immunizati...
Mar 29, 2017•4 min
Author: Aaron Lessen M.D. Educational Pearls: Regularly a patient's creatinine level is an important factor in determining whether a patient will receive IV contrast with a CT because it is thought that contrast can harm the kidneys and could worsen underlying kidney disease. A recent retrospective study compared the rates of worsening kidney problems between patients who received a CT scan with contrast, a CT without contrast, and no CT. The study even included patients with creatinines of up t...
Mar 21, 2017•2 min
Author: Peter Bakes M.D. Dr. Peter Bakes takes us through how he developed his interest in travel medicine as well as some of the more interesting aspects of the specialty.
Mar 11, 2017•33 min
Author: Peter Bakes Educational Pearls: The Neuromuscular Junction (NMJ) is a neuronal synapse in skeletal muscle mediated by nicotinic acetylcholine receptors. Paralytic agents, commonly used in the ED for intubation, include succinylcholine and rocuronium/vecuronium. Succinylcholine is a depolarizing paralytic while rocuronium is a non-depolarizing agent. A newly developed reversing agent, sugammadex, can be used to counter the effects of curonium based paralytics. This is especially helpful d...
Mar 10, 2017•5 min
There are many causes of syncope and a pulmonary embolism may be a commonly missed reason.
Feb 06, 2017•4 min
Electrolytes it's what your bodies crave.
Feb 03, 2017•5 min
What's the difference between an Aortic Dissection and an Aortic Aneurysm?
Feb 01, 2017•4 min
New information about concussion precautions for patients
Jan 31, 2017•2 min
A case presentation of an abnormal rhythm in a younger patient with Lupus.
Jan 27, 2017•3 min
Probably not what Def Leppard were thinking about when they wrote "Pour Some Sugar on Me".
Jan 05, 2017•4 min
Learning about football injuries may not make you a pro bowl player, but it can help you treat patients like one.
Dec 28, 2016•5 min
A discussion on the clinical features and testing for preeclampsia in the ER.
Dec 18, 2016•6 min
Are cervical collars disappearing? Probably not soon, but there are a few reasons why collars may not be as helpful as we think.
Dec 13, 2016•5 min
A few quick tips to help increase the success of defibrillating a patient in persistent ventricular fibrillation.
Dec 07, 2016•3 min
A permutation of the Cincinnati pre-hospital stroke scale to help EMS decide when to take patients to a comprehensive stroke center.
Nov 30, 2016•3 min
