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 …

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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 …

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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 …

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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, …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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Visual Diagnosis # 16

  This 48 yr old male presented to the emergency department with severe mid-epigastric pain worsening over the past 3 days. He describes associated nausea and vomiting without diarrhea or fever. No urinary symptoms. He admits to daily tobacco and alcohol use. He denies any recent illnesses or trauma. His …

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Do you DEWshine ?

  This article is from the Tennessee Poison Center posted on January 26, 2016 by Donna Seger, MD Medical Toxicologist  This past week, the Tennessee poison center was involved in the care of 4 teenagers from Robertson County who drank Mountain Dew mixed with racing fuel (aka Dewshine). Racing fuel (used for …

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Zika Virus

  Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947. In 2014, Zika virus was documented in Chile — the first incidence of the infection in Latin America. As of the most recent data, the countries in Latin America that have reports of Zika virus …

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