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.
I have to say that scuba injuries are not my strong suit. However, in doing this blog post, I have to say it’s not the worst thing to read about. For instance, you get a lot of random information like for some reason depth is measured in fathoms (which is just 2 yards, and seems completely unnecessary to have this). Also since a lot of these disorders were discovered in the 1800s, they have awesome nicknames like the bends, rapture of the deep, the chokes, and all the squeezes including face squeeze and ear squeeze.
For this blog post, I wanted to keep it simple and have it be a quick rundown of the things we need to know when looking at diving injuries as well as when our friends inevitably ask about if it’s okay for them to go diving. And as always, end on some fun history.
Last week’s 5-minute EKG discussion was lead by our APD, Dr. Scott Heinrich.
You get handed this EKG from a patient in triage with chest pain. Should you activate the cath lab?
Goal of This Blog
Pacemakers are becoming increasingly common as our population ages, and are seen more and more in the emergency department. The goal of this post is to summarize common pacemaker settings, the 5-letter nomenclature of pacemakers, indications for pacemaker placement, pacemaker components, common pacemaker complications (majority of blog), and lastly the management of pacemakers in the ED (including applying a magnet). …And as always, the blog ends with some medical history
Part of our new conference schedule is doing a quick 5 minute summary on a journal article of interest, EKG from the past week, and Xray. The idea being that by the end of the year, we will have roughly covered 40 journals, EKGs, and Xray Topics.