Presentation Joey Tribbiani, a previously healthy 28-year-old male, presents to the ED with left-sided flank pain. In the past 12 hours, he has had four 20-minute episodes of sudden onset, severe left flank pain radiating to the groin. During these episodes he was unable to find a comfortable position. He felt nauseous and had one episode of emesis. He denies hematuria and any lower urinary tract, gastrointestinal, or respiratory symptoms. He reports no …
Disposition Decisions: What do we need to consider and why?
Being able to think patients through to their final disposition can be a challenging skill at the clerkship level. However, a good clinician should start thinking about a patient’s disposition as soon as they pick up the chart. Before you take a patient’s history, look at the triage note and start to think through your differential diagnosis, diagnostic workup, therapeutic management, and disposition plan. What are the “most common” and “cannot miss” diagnoses …
Must Not Miss Pediatric Fractures
Andy is a 9-year-old male presenting to the emergency department after a left sided FOOSH injury. The initial survey indicates no other associated injuries or neurovascular compromise. However, Andy is holding his left arm and describes a poorly localized pain along his wrist and forearm preventing him from moving it. His immunizations are UTD and he is otherwise healthy without any history of orthopedic injuries. What are your differential diagnoses? What findings on …
“Help us help you” – Soliciting Feedback in the ED
We’ve all heard the adage that practice makes perfect and to become an expert you must complete 10 000 hours of deliberate practice1. This involves motivated, goal oriented, purposeful practice with periodic feedback. Feedback is critical to allow for growth from where you currently are as a clinical clerk to where you want to be as future practicing physician2. Even with extensive deliberate practice, you will plateau without guidance and identification of areas …
Identification of Emergency Department Patients for Referral to Rapid-Access Addiction Services
This month, CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at substance-related ED presentations and the need for direct referral to a rapid-access addiction services. Recent national data shows that substance-related emergency department visits are rapidly increasing.1 Despite this finding, previous studies show that many EDs do not have referral protocols for rapid-access addiction services.2 A prospective cohort study was conducted by Hann et al. to better characterize substance-related …
Approach to Caring for Homeless Patients in the ED during the COVID-19 Pandemic
Introduction It’s a cliche that holds true now more than ever – the emergency department really is the front door to the medical system. Despite many health and social services shuttering or moving to virtual care during the COVID-19 pandemic, the emergency department remains open 24/7. Our EDs are still committed to seeing anyone who shows up, in communities of all sizes from coast-to-coast. And while we try to keep people at home …