First trimester vaginal bleeding is a common complaint seen in the Emergency Department (ED). Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies. There have been multiple studies questioning the interrater reliability of the pelvic examination. But is there added utility to the examination once the presence of an intrauterine pregnancy (IUP) has been established?
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Journal Review
Utility of Pelvic Exam in 1st Trimester Vaginal Bleeding
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Femoral Neck Fractures
This post explores femoral neck fractures – classification, diagnostics and management.
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Journal Review
Should All Admitted Patients with Ascites Get a Paracentesis?
Ascites is the most common complication of liver cirrhosis, and infection of that abdominal fluid, spontaneous bacterial perotinitis (SBP) is both common (reported in 10-30% of hospitalized patient) and deadly, with a mortality rate of 10%. SBP can be diagnosed by analysis of ascitic fluid obtained by a simple bedside diagnostic paracentesis, a procedure well within the scope of all emergency medicine physicians.
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Pediatric Supracondylar Fractures
This post dives into the management of supracondylar fractures and talks about some of the complications to look out for.
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Journal Review
Validation of The Pittsburgh Infant Brain Injury Score for Abusive Head Trauma
Abusive head trauma is the leading cause of death from child abuse and the leading cause of death from traumatic brain injury. Identification of clinically important traumatic brain injury is essential. The PECARN head trauma rule for children less than 2 years of age includes 6 predictors (PECARN 2009). The predictors of “acting normally as per parents” and “a high-risk mechanism of injury” may be unreliable in infants with abusive head trauma.
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Initial Trauma Assessment
This post dives into the basics of the initial trauma evaluation.
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Journal Review
Diagnostic Accuracy of IVC Collapsablity to Predict Fluid Responsiveness in Spontaneously Breathing Patients
Background: Assessing fluid responsiveness in patients in shock is crucial as fluid balance is important in their management. Identifying patients who are fluid responsive allows us to rapidly increase their cardiac index. However, rapid infusion does not benefit all patients in shock and in some, may be harmful. As a result, it is crucial to identify parameters that can aid in identifying patients who may benefit from volume expansion.
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Subtalar Dislocation
This post discusses the uncommon but important to recognize subtalar dislocation
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