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 …
Clinical question: Is the Bier Block safe and effective analgesia in the ED?
A 12-year-old healthy male fell while learning how to use his hoverboard. An X-ray done in the ER shows a displaced distal radius fracture, amenable to reduction and non-surgical management. While discussing the reduction technique, his parents request analgesia with as little sedation as possible because they don’t want him “put to sleep.” You recall reading about a type of regional anaesthesia for the upper extremities but do not know the effectiveness and …
Isolated distal DVT – Diagnosis and Management
Case: [bg_faq_start] A 51-year-old woman presents to the ED with the chief complaint of left leg swelling. She recently underwent bunion correction surgery to her left foot 7 weeks ago, and her cast was removed one week ago. Over the last day or two she has had significantly increased leg swelling and more recently reports some dull pain described as” heaviness” to the affected leg. The patient denies chest pain, shortness of breath, …