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Tiny Tips: ICH for ICH – Brain Herniation

In Medical Concepts, Tiny Tips by Amit PersadLeave a Comment

Brain herniation is a catastrophic sequela of increased intracranial pressure (ICP) or local mass effect from intracranial lesions. Different types of brain herniation can occur depending on the location of mass effect and how rapidly this mass effect develops.1 Any mass lesion, including hemorrhage, tumor, vasogenic or cytotoxic edema, trauma or infection can cause herniation. However spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury (TBI) are common causes of herniation in the acute …

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Blood and Clots Series: My patient has a pulmonary embolism. Should I screen them for cancer?

In Blood & Clots, Medical Concepts by Eric TsengLeave a Comment

CanMEDS Roles addressed: Expert, Leader An 83 year old female presents for follow-up after completing 3 months of oral anticoagulant therapy with Rivaroxaban for her unprovoked deep vein thrombosis. She did some research online and heard about a link between venous thrombosis and cancer, and asks why you are not getting a CT scan to rule out malignancy. Should you screen her for cancer? If so, which tests are necessary? What is the …

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Wellness Criteria for P.E. (Practice Enjoyment)

In Infographics by Gerhard DashiLeave a Comment

Editors Note: As part of emergency medicine’s annual wellness week (#iEMWell18), Dr. Gerhard Dashi riffed off of the well known Well’s Criteria for Pulmonary Embolism to create the Wellness Criteria for Practice Enjoyment! Score yourself using our infographic to determine how likely it is that you are enjoying your practice! When to use the Wellness Criteria: The Wellness Criteria risk stratifies residents for P.E. (practice enjoyment) and provides an estimated pre-test probability. The …

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Syncope: what (if any) investigations are required?

In Featured, Medical Concepts by Shahbaz SyedLeave a Comment

Syncope is a common problem encountered in the Emergency Department, and yet despite this there are few strong consensus guidelines, and significant practice variation. Here we seek to explore some of the evidence regarding syncope care. The vast majority of literature and recommendations on syncope in this post, are based upon the well patient who has a syncopal event and is now well again. The differential diagnosis in this scenario is actually fairly …

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Blood and Clots Series: What are the risks of reversing DOAC-associated intracranial bleeding?

In Blood & Clots, Medical Concepts by Andrew ShihLeave a Comment

CanMEDS Roles addressed: Medical Expert Case Description You are seeing a 54F in the emergency department after she sustained a mechanical fall. She struck her head on the pavement and is now confused. Her comorbidities include: hypertension, diabetes mellitus, and atrial fibrillation.  She has been taking rivaroxaban 20 mg daily for three years without incident. Her complete blood count (CBC) demonstrates a white blood cell (WBC) count of 7.9 x 109/L, hemoglobin of …

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Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic

In Medical Concepts, Tiny Tips by Sean PatrickLeave a Comment

Peripheral neuropathy is prevalent in up to 2.4% of the general population1. It is often characterized by an asymmetric distribution with sensory symptoms following a dermatomal pattern. Initial investigations include a complete blood count (CBC), metabolic panel (electrolytes, glucose, urea, creatinine), and thyroid stimulating hormone (TSH)2. There are many causes for peripheral neuropathy, so when considering the etiology, think “TREADMILLS.” Toxins Ethanol, Heavy metals, Tetanus, Organophosphates, Diphtheria Renal Failure Endocrine Diabetes, Hypothyroidism Acquired …