While working in your emergency department, you receive news a number of patients have been found at a bus station unconscious. It is suspected that some sort of attack may have occurred. The first patient is brought to your ER, with obviously soiled clothing, vomiting and aggravated. As you make your way towards the bedside, the patient suddenly begins to seize. Overview: This past month, the assassination attempt of a Russian ex-spy and …
When and how to treat hyponatremia in the ED
Electrolyte imbalances like hyponatremia can be the cause of a variety of vague complaints. At the same time, patients may present with electrolyte abnormalities that are asymptomatic and are incidental findings on bloodwork. Here’s an approach to deciding when and how to treat hyponatremia in the emergency department. We also thank Drs. Joel Topf (@kidney_boy) and Dr. John Neary (@jddneary) for their valuable input on this article! The Case Marjorie, an 83-year-old female, …
Clinical Question: Can Ventolin improve wheeze in heart failure?
A 70-year-old male calls EMS with a 3-day history of shortness of breath. He sleeps in a chair because his breathlessness is made worse while lying on the flat of his back. He is working hard to breath and has difficulty speaking in full sentences. Physical examination reveals an elevated JVP, a third heart sound, and wheezes bilaterally with fine inspiratory crackles. He also has bilateral pitting edema to his hips. Vitals include a …
How useful is the physical examination in suspected cauda equina syndrome?
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 …
I Kneed You – The Thessaly Test for Meniscal Injury
The Case You are working a shift in the ambulatory zone of your emergency department. Your next patient is a 27 year old female with a chief complaint of “lower extremity injury”. On history, her right knee has been sore for the past 2 days, with swelling and worsening pain since last night, and she is now unable to weight bear on her right leg. She has no recent trauma, is not sexually …
Clinical Question: Are ESR and CRP useful tests when evaluating an adult patient with potential septic arthritis?
Monoarthropathies are common and carry a broad differential including infection, trauma, lupus, rheumatoid arthritis, or crystal arthropathies.1–3 Of these, the can’t miss diagnosis is septic arthritis, as delayed treatment can cause irreversible joint destruction with a fatality rate up to 11% if not treated.4 Yikes. The Patient You are working in minor treatment and a 70-year-old gentleman presents with pain in his left knee that has been worsening over the past week. It …