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Cases

March 2016

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“a piece of turkey stuck in my throat”
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Journal Review

Spectrophotometry or Visual Inspection for Xanthochromia

Filed Under: Tags: , , , , March 3rd, 2016 Leave a Comment

Although non-contrast head CT (NCHCT) has near perfect sensitivity (98-100%) in detecting aneurysmal subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset, sensitivity declines after 6 hours. As a result of declining sensitivity, lumbar puncture (LP) continues to be part of the workup in suspected SAH. An LP gives providers the ability to perform CSF analysis for red blood cells and detect xanthochromia by visual inspection or spectrophotometry.
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Radial Head Fracture

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Radial head fractures are common injuries that are frequently missed. This post reviews the exam, X-ray findings and management.
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Journal Review

Risks of Aggressive Reduction of Door-to-Balloon Time

Filed Under: Tags: , February 25th, 2016 Leave a Comment

The advent of percutaneous coronary intervention (PCI) led to a decrease in morbidity and in-hospital mortality for patients presenting with ST-elevation myocardial infarctions (STEMI). In 1999 the American College of Cardiology and American Heart Association updated their guidelines with the benchmark door-to-balloon time (DTB) to be less than 90 minutes. It has since been adopted as a measure of quality with many hospitals attempting to achieve faster times with the thought that shorter times will improve clinical outcomes.
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Core

C-Spine Injuries + CT Interpretation

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An in depth review of devastating injuries of the cervical spine. See the ABCs of of Reading C-Spine CTs post for some basics.
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Journal Review

Identification of High-Risk ACS Patients Using POC Echo

Filed Under: Tags: , , , February 18th, 2016 Leave a Comment

Current American Heart Association (AHA) recommendations suggest that high-risk patients with unstable angina or NSTEMI should undergo early invasive intervention. Risk stratifying these patients generally relies on serial EKGs and troponins, which can delay findings and subsequent intervention as these tests require time and do not have optimal sensitivity or specificity.

Though not a traditional part of the Emergency Department (ED) workup,
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Core

Testicular Torsion

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Testicular torsion is a time sensitive, surgical emergency.This post reviews what to look for on presentation of the acutely painful scrotum
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Journal Review

Isopropyl Alcohol in the Treatment of Nausea

Filed Under: Tags: , February 11th, 2016 One Comment

Nausea is a common complaint seen in the Emergency Department (ED). Although there are a number of agents available for treatment, the efficacy and safety of these drugs have recently come into question. Metoclopramide is a commonly used antiemetic agent but it carries significant side effects including akathesia and tardive dyskinesia. Ondansetron is another central acting drug that has been shown to be effective in nausea prophylaxis in patients receiving chemotherapy but has a black box warning due to its effect of prolonging the QT interval.
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