Background
Most children begin walking between 12 and 18 months. Their initial gait starts broad-based, often with short asymmetric steps. At faster speeds, they often develop foot slapping and asymmetric arm swinging. By ages 3-5 years-old, children start to walk with more fluidity and symmetric strides. By ages 5-7 years-old, their gait begins to resemble the same pattern as an adult.…
Patients who have a history of IBD: chronic abdominal pain, diarrhea, fever, weightloss; coming into the emergency department for these same symptoms; how do we handle chronic disease in the emergency department?
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Intro
This blog post covers identifying the need for MTP, MTP protocol, goals of therapy, evidence behind MTP, adjuncts to MTP, and newer testing for coagulopathy. There is also a review of blood transfusion reactions.
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As emergency physicians, we know how to handle bleeding. But what about when the patient is on anticoagulants? Last week our ED pharmacist, Gary Peksa, PharmD, gave us some advice on how to stop the bleeding in a patient on anticoagulants. Here is a brief overview on what he taught us. Let’s start by discussing all the intricacies of the coagulation cascade and how each of the anticoagulants work:
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Last week we had the opportunity to learn about posterior circulation ischemic strokes from vascular neurologist, Dr. Osteraas.
Diagnosing posterior circulation ischemic strokes can be challenging in the emergency department, largely because posterior circulation ischemic strokes frequently lack “traditional” stroke signs and symptoms and the symptoms that you do see are often non-specific and can be slow onset. Despite this, it is important to do our best to diagnose these as about 20% of ischemic events involve the posterior circulation and posterior circulation ischemic strokes can lead to some of the most devastating neurologic outcomes, including massive cerebellar infarcts with subsequent herniation and locked in syndrome.
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Here’s some how to’s when it comes to burns. First off- do your ABCs. Get your history from the patient, from family, from EMS. You need to figure out the mechanism of this burn. Was this an explosion? You may need to worry about associated injuries. Was this inside? You may need to worry about…
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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. …
Dr. Patwari did a great review on differentiating ST elevations associated with pericarditis vs. acute MI. From medical school, I think we can recall many of the classic EKG findings that support pericarditis Diffuse ST elevations Concave upwards STE PR depressions in multiple leads (only reliable seen in viral pericarditis) PR elevation in aVR However,…
