Knee Dislocation and Vascular Injury

  A knee dislocation, not to be confused with a patella dislocation, is a rare, but potentially limb-threatening injury. Most often caused by high-velocity trauma, knee dislocations account for less than 1.2% of orthopedic trauma. Knee dislocations often result in injury to multiple cruciate ligaments of the knee, but can also cause neurovascular …

Read More »

Long Q-T syndrome

    The Q-T interval represents the time of ventricular activity including both depolarization and repolarization. It is measured from the beginning of the QRS complex to the end of the T wave. Normally, the QT interval is 0.36 to 0.44 seconds (9-11 boxes). The QT interval will vary with patient …

Read More »

Approach to the inconsolable infant

  Case: Parents bring a 2-month-old male infant to the emergency department for evaluation. Parents state the child “has been crying excessively over the past 24 hours and has been at times inconsolable.” Is this crying normal? The definition of normal crying originates from a 1962 article by T. Berry Brazelton, who determined …

Read More »

Calcaneal Fractures

  Case: 24 yr male with acute alcohol intoxication brought in by ambulance. While performing some parkour stunts he fell approximately 4 meters, landing on his feet. His only complaint is right foot pain. He denies neck, chest, abdominal, back or pelvic pain. His vital signs are stable. After your …

Read More »

Tick Paralysis

  Tick paralysis can occur worldwide and is associated with over 40 different species of tick. Tick paralysis occurs when an egg-laden female tick produces a neurotoxin and transmits it to its host during feeding.  Unlike other tick born diseases suck as Lyme disease, ehrlichiosis, and babesiosis which are caused …

Read More »

the ABCs of VADs

  Case: You are walking through the airport terminal when you notice a commotion and group of people standing around an unconscious middle-aged female. You run over and identify yourself as a trained emergency provider and assess the patient. She is unresponsive and not breathing. There are no signs of …

Read More »

Visual Diagnosis # 17

  Case: 54 yr M with a history of rectal cancer and type II diabetes presents to the emergency department with pain and erythema to the left buttock.  Symptoms began last night with minimal irritation and he initially thought he had a rash. He awoke this morning with worsening pain, …

Read More »

BRUE is the new ALTE

    The term ALTE in pediatrics had previously referred to apparent life-threatening event. This event was characterized by some combination of apnea, color change, change in muscle tone, choking or gagging and was also witnessed by and distressing to a caregiver. This was the definition from the National Institute of …

Read More »

Chest X-ray: The step-by-step approach

  When interpreting a chest x-ray it is important to have a systematic step-by-step approach. It is critical to be able to identify the basic anatomy on a chest x-ray.   One helpful way is to use a mnemonic. One popular mnemonic is DRS.ABCDE D – Details  Date, patient name and date …

Read More »

Ectopic Pregnancy

  Ectopic pregnancy is a pregnancy which implants outside the endometrial cavity. These pregnancies will ultimately result in the death of the fetus. An ectopic pregnancy is an abnormal pregnancy which, without timely diagnosis and treatment, can become a life-threatening situation. 2% of all US pregnancies are ectopic and 98% of ectopics …

Read More »

Visual Diagnosis # 17

  A 14 yr male presents with pain and swelling to the left eye. Mother states he recently had a mild illness with cough and sinus congestion within the past 2 weeks. Over the past 3-4 days he has developed left eye pain and swelling.  He currently has a fever …

Read More »

DYSPNEA for DUMMIES – Part 1

    Dyspnea is defined as abnormal or uncomfortable breathing in the context of what is normal for a person according to his or her level of fitness and exertional threshold for breathlessness. Dyspnea is a common symptom and can be caused by many different conditions. Dyspnea can be acute …

Read More »

Six reasons to avoid fluoroquinolones in the critically ill

    Fluoroquinolone antibiotics already carry warnings about the risks of QT prolongation and torsades de pointes, tendonitis and tendon rupture as well as central nervous system effects, including peripheral neuropathy and exacerbation of myasthenia gravis. The FDA had recently updated the labels to state that “the serious risks posed by fluoroquinolones …

Read More »

Is Immodium the poor man’s methadone?

  Loperamide is the active ingredient in Immodium, an over-the-counter antidiarrheal agent which also has μ-opioid receptor agonist activity. With therapeutic oral dosing, loperamide acts on μ-opioid receptor in the gastrointestinal tract and does not enter the central nervous system. At recommended doses, opioid effects on the central nervous system are …

Read More »

Ticks suck !

  There are numerous tickborne diseases that  can infect humans and cause disease. Several different tick species are responsible for transmitting these diseases and can be found throughout different geographic regions of the United States. In addition, some tick species can transmit more than one disease. Symptoms can be similar …

Read More »

Dangerous New Street Drugs: W-18

   In the midst of the opioid epidemic, there has emerged another potentially more dangerous drug – W-18. This synthetic opioid is thought to be 100 times more potent than fentanyl and 10,000 x more potent than morhpine.   In a single drug seizure in Calgary in August 2015, W-18 …

Read More »