Chikungunya (Emerging infections series #2) By Casey M. Clements M.D., Ph.D. (@CaseyClmnts) and Donald F. Zimmer M.D. Photo: Luz Sosa, PAHO/WHO – used according to the creative commons license. Why emergency physicians should care: 1.There is a large outbreak in the Caribbean this year which has spread into Central America and the United States 2.This usually self-limited infection causes debilitating pain and often has a prolonged course and patients may seek emergency care. 3.This is an emerging infection with potential to spread across portions of the United States
Author: Henrique A. Puls / @HAPuls Reviewed by: M. Fernanda Bellolio, M.D. There are two major reasons to stop a trial earlier than planned for benefit: the unethical situation of keeping the randomization process even with good results, and the idea that research resources should be allocated to other project after the study question is solved. These two reasons imply the question was correctly addressed and evaluated with the data available; however, early data from Randomized Controlled Trials (RCT’s) are not reliable to answer research questions. Let’s explore why.
Author: Stephanie Polites, M.D. General Surgery Resident. Mayo Clinic. Acute appendicitis is the most common surgical emergency in children and accounts for many emergency room visits and hospitalizations in the pediatric population. Traditionally, the diagnosis was made based on history and physical exam, with use of advanced imaging such as ultrasound or computed tomography (CT) reserved for equivocal cases. Now that CT is readily available in most emergency departments, there has been a substantial increase in CT utilization. CT is more than 90% accurate in diagnosing acute appendicitis and providers hope its utilization will avoid negative appendectomies. Unfortunately there may be a long term risk of cancer associated with ionizing radiation exposure due to CT. Furthermore, there is evidence that CT utilization does not prevent negative appendectomies.
Interview with the one, only and extraordinaire Donald Jenkins, M.D. http://youtu.be/r7ASZgOBlG0
Author: Jessica Schwarz, M.D. This is a Mayo Clinic Emergency Medicine Residency Interesting Case Presentation using the Pecha Kucha format http://youtu.be/9ArfbGTp9zk Reviewers: Cameron Wansgard, M.D & Daniel Cabrera, M.D
Video by Franco Utili, MD and Margarita Jullian, MD Medicina de Urgencia UC / @UrgenciaUC http://youtu.be/2cV41r9VxaI
Author: Theresa Tran, M.D. This is a Mayo Clinic Emergency Medicine Residency Interesting Case Presentation using the Pecha Kucha format http://youtu.be/Bn-bomiyD8I Reviewers: Cameron Wansgard, M.D & Daniel Cabrera, ...
In recent years we have witnessed a huge increase in the interest and activity around the areas of clinical decision making and cognitive aspects of our clinical practice. This is largely because of the herculean work and influences of emergency medicine heroes like Patrick Croskerry and Gloria Kuhn, constructing on the research and theories of authors like Daniel Kahneman and Steven Sloman.
UPDATE: John Maeda posted these laws on the Laws of Simplicity website. Here how John Maeda's (@johnmaeda) Laws of Simplicity apply to Emergency Medicine: ...
Video by University of Ottawa Emergency Medicine / @emergmedottawa https://www.youtube.com/watch?v=nrxuZwFpigI&feature=youtu.be
5 Simple Steps in the Ankle Block A 33 year-old (60-kg) male is brought into your emergency department by EMS and appears to be in excruciating pain. As EMS is transferring the patient, they explain that the patient was mowing grass on a steep incline about 40 minutes ago when the lawnmower slid over his right foot causing amputation of his first through third toes. The toes were placed on ice and the patient notes no other injuries. No pain medicine has been given. Nursing obtains vitals which are normal aside from some mild tachycardia. IV access is obtained. 6-mg of morphine is immediately administered after the patient confirms no allergies. Head to toe assessment and review of systems reveals no other injuries aside from the toe amputation of the right first through third with all three amputations occurring through the proximal phalanxes with pieces of bone jutting out and bleeding well controlled. The patient denies any past medical history. You quickly identify that this is a Gustilo Class IIIB open fracture and you order IV cefazolin, gentamicin and you throw in some penicillin because of your concern of anaerobes as you find the amputation occurred on a farm. You have the toes, which appear fairly well preserved, wrapped in moist gauze, placed in a bag of normal saline and placed on ice; you take special care to not have the toes directly placed on ice. 20 minutes has passed and re-evaluation of the patient reveals that he is still in excruciating pain, so you repeat the morphine. You call your orthopedic doctor on call who commends you on the antibiotics, says that they typically will not reattach toes, but she does agree that the wound will need to be taken to the OR for a wash out. Unfortunately, she is stuck in another case in the OR and it will probably be 2-3 hours before she can take him because a pretty involved trauma case just rolled in several minutes ago. The orthopedic surgeon asks, “Can you keep the patient comfortable until then?” Meanwhile the patient’s nurse approaches you and states that the repeat morphine has barely touched the patient’s pain. You repeat the morphine, but you think: what are my next steps in pain management?
Digitalis Toxicity Damian Baalmann, 2nd year EM resident A 67 year-old female (90-kg) is brought into your emergency department because of increasing confusion. As the nursing staff is hooking the patient up to the monitor, the patient’s daughter comes into the room explaining that the patient has a history of atrial fibrillation, CHF, renal failure, and lives at home with the patient’s husband. Over the past several days, the patient has had increasing confusion, weakness, malaise, and anorexia. The patient’s daughter also hands you a medication list that includes furosemide, digoxin, sublingual nitroglycerin, and baby aspirin. Vitals are bp 94/54, RR 16 breaths per minute. Exam reveals elderly appearing woman in moderate distress with clear lungs sounds and irregular tachycardic heart sounds with S3. Extremities have 1+ pitting edema. Electrocardiogram is obtained and is shown below. What are your next steps in management?