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 MoreWelcome to another grand rounds recap! This week Dr. Isaac Shaw started us out with the monthly Morbidity and Mortality. Dr. Stolz then dove into some ultrasound QA, covering topics such as knee arthrocentesis and early pregnancy ultrasound. Dr. Murphy followed this up by discussing the science of motivation and how we can use this in the Emergency Department setting. This was followed up with Drs. Modi and Kircher who went head to head in this months CPC on endocarditis. Dr. Irankunda finished up the day with an excellent talk on the retrograde urethrogram. See you next week!
Read MoreSpinal epidural abscess - what was once a 'white whale’ diagnosis in the Emergency Department, has, with the opiate epidemic and rise in IV drug use, become a consistent specter in our differential diagnoses. Potentially debilitating, potentially deadly, devilishly difficult to diagnose in it’s early stages; spinal epidural abscesses have become a persistent concern for patients presenting to the ED with back pain. Much like syphillis, lupus, and HIV, the response to the question of “could it be a spinal epidural abscess?” is usually “ughh, yeah I guess so.” In this article, we will briefly cover the pathogenesis and presentation of spinal epidural abscessed and delve more deeply into the question of how best to treat these patients? What are the triggers for surgical intervention? Are patient’s with neurologic deficits doomed to a life of persistent neurologic disability?
Read MoreThere are some areas in our practice where the literature grants us a somewhat sure path forward in the evaluation of our patients. The decision whether or not to pursue cervical spine imaging studies following a traumatic mechanism of injury is one of these areas. The NEXUS criteria and Canadian C-Spine Rule are useful guides for the evaluation of these patients. What comes after the imaging can be a bit more challenging. What do we do with patients who have persistent pain but negative imaging? To what extent do we pursue the possibility of a ligamentous injury? Must we wait for all patients to be sober so that we can "clinically clear" them in addition to our radiographic clearance. The 3 articles below seek to answer some of these challenging questions. Take a listen to the podcast and read the summaries to familiarize yourself with some of the latest literature addressing these challenging patient care scenarios.
Read MoreIt's another back pain type of day in Minor Care. 3 hours into your shift and you've seen 6 patient's with back pain. You quickly evaluate them asking them about red flag symptoms, searching for signs of neurologic injury on your physical exam. As you talk to Jane, your next patient, you get worried she doesn't have simple musculo-ligamentous back pain. Jane has a history of IVDU and states her last use was 3 months ago. She cites some subjective fever and chills over the past several days along with aching low back pain which has been getting steadily worse. On exam, you find she is febrile with a temperature of 101.4, tachycardic to 110, with a normal blood pressure. She has midline upper lumbar and lower thoracic spinal tenderness to palpation.
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.
