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Boring Question: What is the role of the FAST exam for blunt abdominal trauma?

In Clinical Questions, Medical Concepts by Michael ButlerLeave a Comment

You are working an overnight shift in the emergency department when a 40 year-old male passenger involved in a high-speed motor vehicle collision arrives. His vital signs include a blood pressure of 88/56 mmHg, heart rate of 112, and respiratory rate of 16. His Glasgow coma score is 12 (3E, 4V, 5M). En route, your patient received 2L of normal saline with no change in his blood pressure. On exam, his abdomen is tender …

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Boring Question: What is the role of xanthochromia in ruling out SAH?

In Clinical Questions by Patrick Bafuma6 Comments

The Case Your first patient of the shift is a 19-year-old male with “the worst headache ever.” His mother states she’s quite worried because he “never gets headaches.”  He had some slight nuchal rigidity, but is afebrile.  And as such, you arranged a non-contrast CT Head, which was found to have a normal without signs of intracranial hemorrhage.  Now, 12 hours after onset of his headache, and after discussing the risk and benefits …

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Boring Question: What is the risk of Contrast-Induced Nephropathy?

In Clinical Questions by Michael Garfinkle3 Comments

I once encountered a patient who was empirically started on warfarin therapy after a presumed diagnosis of pulmonary embolus. The treating team did not want to risk an AKI by performing a CT-PE as the patient’s creatinine was 120 and a V/Q scan was not an option due to underlying lung disease. This made me uncomfortable. There’s a known risk of hemorrhagic stroke (~0.5% per year) and other major bleeding events with warfarin, …

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Boring Question | Are wound closure strips an acceptable alternative to tissue-adhesives?

In Clinical Questions by Patrick Bafuma1 Comment

Your next patient is a seven-year-old boy with a 3 cm linear laceration to his calf that he sustained sliding into second base during his little league baseball game. The patient was seen 3 months ago for a facial laceration that was repaired with sutures according to his mother. She reports he was very uncomfortable with the stitches last time, and would like to know “if there is some other way to do …

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Boring Question | Do patients with liver disease need FFP before procedures?

In Clinical Questions by Michael Garfinkle1 Comment

I was recently asked to give fresh frozen plasma to a patient with liver disease and an elevated INR before a therapeutic thoracentesis. He was otherwise healthy and had no history of bleeding diathesis. While I was asking for consent and explaining the risks and benefits of blood product transfusion, I began to wonder about the true benefits in his case. Knowing that liver failure leads to both pro and anti-coagulant deficiencies, I wondered: Is an elevated …