I recently wrote a post about the utility of the HINTS exam for patients who present with persistent vertigo known as acute vestibular syndrome (AVS). The available evidence suggests that this bedside exam is highly effective to help differentiate peripheral from central causes. And in one study, it may even be better than an MRI in the first 48hrs [1]! Finally, the answer to all of your vertiginous problems in the emergency department…except …
Tiny Tip | Canadian C-spine Rule Mnemonic
Clinical Decision Tool uptake In 2007, Dr. Ian Stiell wrote a paper [1] about the uptake and real-life implementation of his four clinical decision rules (or as we prefer to call them, clinical decision tools). The paper concludes that “Future research should identify implementation barriers and explore strategies to achieve better knowledge uptake in the ED”. The BoringEM team hypothesizes that the ease of use may be greatly affected by the complexity of a rule itself …
Boring Question: How useful are physical examination manoeuvres for an adult patient with suspected meningitis?
Background For a patient who presents with a headache, it is imperative to consider a broad initial differential diagnosis to rule out life threatening causes such as meningitis. Bacterial meningitis is a medical emergency with an annual incidence of 4 to 6 cases per 100,000 adults, with early treatment considerations being essential (1). We are commonly taught to consider a triad of symptoms including fever, neck stiffness and altered mental status. However, the …
KT Corner: Isolated Loss of Consciousness in Pediatric Head Injury
In this post, Dr. Kirsten Weerdenburg reviews a recent article looking at the value of isolated loss of consciousness in children with blunt head injury as a predictor for clinically significant brain injury on CT. Article Title: Lee, Lois K., et al. “Isolated loss of consciousness in children with minor blunt head trauma.” JAMA pediatrics 168.9 (2014): 837-843. DOI: 10.1001/jamapediatrics.2014.361 Why this paper is important? Loss of consciousness (LOC) is an element on history that frequently influences …
Tiny Tip: Determining capacity in an emergency – The CURVES Mnemonic
Determining capacity in a patient that needs to make an emergency medical decision can be a huge challenge for emergency physicians with substantial legal and patient-oriented consequences. As emergency medicine providers we need to be able to make this determination confidently and decisively. By preparing our approach in advance we can be more confident in our decisions. In November 2014, EM:RAP (check it out!) had a great segment on decision making capacity and …
KT Evidence Bite: Comparison of the Canadian CT Head Rule and the New Orleans Criteria
Editor’s note: This is a series based on work done by three physicians (Patrick Archambault, Tim Chaplin, and our BoringEM Managing editor Teresa Chan) for the Canadian National Review Course (NRC). You can read a description of this course here. The NRC brings EM residents from across the Canada together in their final year for a crash course on everything emergency medicine. Since we are a specialty with heavy allegiance to the tenets of Evidence-Based Medicine, we thought we would serially release the biggest, …