5-Minute Journal Article (PECARN Head CT Rule)
Dr. Brian Yu did a great 5-minute summary on the PECARN head CT Rule that was published in 2009. It’s an ambitious study that involved 25 emergency departments and included 42,412 patients under the age of 18 years who presented with blunt head trauma. It further risk stratified these patients into 2 major cohorts of <2 years of age and 2-18 years of age. It excluded patients with trivial injury, penetrating trauma, neurologic history, and those with prior imaging. The outcomes this study aimed for were clinically important findings including death, need for neurosurgical intervention, intubation >24 hours, and admission >2 nights.
Here’s a summary of the more common forearm fractures and what to do about them.
Dr. Somy Thottathil did an awesome lecture on bioterrorism this past week. And although it is hopefully something we never have to see, as one of the major hospitals designated as a bioterrorism site in Chicago, it is something that we should be prepared to recognize and treat. It’s also good review for all the med school knowledge we haven’t needed (thankfully) for some time now. The main topics we’ll focus on are the Category A agents: Botulism, Plague, Anthrax, Smallpox, and Viral Hemorrhagic Fevers (which includes Ebola, Marburg, Lassa Fever, and Crimean-Congo Hemorrhagic Fever). We are only going to discuss Ebola as current outbreaks are still occurring.
Heres the no frills details behind ITP and TTP. Your board scores can thank me later.
You stroll into work, coffee in hand, and you’re feeling great today. Your first patient is being escorted to her room. She’s young, maybe in her early 30s, walking without difficulty, chatting with the person showing her the room. You think to yourself, why is she here? You sign into the computer and you see the chief complaint: elevated blood pressure. But she’s so young you say to yourself. You wait for the nurse to load the blood pressure in the computer and take a sip of your coffee. It loads: 162/98. You ask if the patient has any other symptoms. The nurse says no and lets you know that the patient has no past medical history. You smile to yourself thinking easy discharge! You take another sip of coffee (well deserved).
Okay, so cancer is a broad, difficult topic that I will never be able to cover in one blog post. But we just had a very informative lecture by our very own, behind enemy lines, EM/IM master: the He-Gore. So I’ll touch on a few of the possible cancer related emergencies that he helpfully walked us through.
Thyroid emergencies are an interesting class of disorders. They’re rare, but are an acute, life-threatening group of syndromes. This is in contrast to the vast majority of thyroid cases that often present with minor symptoms (or found on routine labs), only requiring outpatient treatment and medications. Thyroid emergencies are the extreme versions of these thyroid disorders. They fall into two categories: “too low” of thyroid hormone (myxedema coma) and “too high” of thyroid hormone (thyroid storm). The post starts with some background anatomy and physiology, and then dives into each disorder separately. Also briefly discusses Levothyroxine overdose.
Last week we had an ENT sim, lead by our always helpful ENT colleagues, focusing on 4 ENT emergencies we should all be familiar with:
- Auricular hematoma
- Peritonsillar abscess
Big thanks to Dr Schiebler who came to conference to drop radiologic-knowledge bombs on us. This lecture was loaded with tons of information; here are some of the big take-aways!
This week’s 5-minute Journal Article discussion covered
“Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children” by Kocher et al.
Why is it important to differentiate between septic arthritis and transient synovitis in pediatric patients? Because both diseases can present similarly with acute onset of pain, fever, limp or inability to bear weight and patients holding their hip in the flexed, abducted, externally rotated (FABER) position. The difference is transient synovitis is exactly that, transient, while septic arthritis can lead to permanent joint damage and disability if not treated aggressively with surgical intervention and IV antibiotics.