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How useful is the physical examination in suspected cauda equina syndrome?

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Background Cauda equina syndrome (CES) is a syndrome consisting of one or more of the following: (1) bladder and/or bowel dysfunction, (2) reduced sensation in the saddle area (i.e. the perineum and inner thighs), and (3) sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss or reflex change) [1]. The cauda equina is a latin name meaning horse’s tail and represents nerve roots L2 through L5. CES is caused by …

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Clinical Question: How useful is the β-HCG discriminatory zone in a suspected ectopic pregnancy?

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For female patients presenting to the emergency department with a positive serum β-HCG as well as abdominal pain, vaginal bleeding, syncope, or hypotension, the prudent emergency physician must rule out an ectopic pregnancy (EP). This potentially life-threatening entity is estimated to occur in 1.5 to 2% of all pregnancies and ruptured ectopic pregnancies account for 6% of all maternal deaths [cite num=”1″]. Point-of-care ultrasound (either trans-abdominal or trans-vaginal) has become the standard of …

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Tiny Tip: Anaphylaxis Treatment

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Anaphylaxis is a common presentation to the emergency department requiring rapid treatment as death can occur within minutes. From 1986 – 2011, in Ontario, Canada alone there were 82 deaths from anaphylaxis (1). Epinephrine 0.5mg IM (1:1000) is the first line treatment for anaphylaxis and the only lifesaving treatment (2). The other medications are for symptomatic control or can help prevent the biphasic reaction anywhere from 8-72 hours from the initial reaction. For …

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Tiny Tips: Epinephrine Dosage

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Epinephrine is a commonly used medication in the emergency department for the management of anaphylaxis and cardiac arrest. Administering this drug can be confusing as the dosage and concentration are different for each indication. The “allergy epi” 1:1000 concentration is 10 times more concentrated than the “cardiac epi”. The “allergy epi” is delivered IM while the “cardiac epi” is delivered IV. This difference leads to an increased risk of error as the incorrect …