22 10, 2014

Diagnose on Sight: 6 year old with elbow pain

By |October 22nd, 2014|Diagnose on Sight, Orthopedic, Pediatrics|0 Comments

elbowCase: A previously healthy 6 year old male presents with left elbow pain after wrestling with a friend. What is the diagnosis? Click on image for a larger view.


20 10, 2014

Antibiotics, Myasthenia Gravis, and Risk of Weakness

By |October 20th, 2014|Rheumatology, Tox & Medications|2 Comments

antibioticsA 71 year old female presents to the ED with lethargy, fever (39.5 C), and tachypnea (RR 28 rpm). She has a long-standing history of myasthenia gravis (MG) for which she receives periodic IVIG infusions. She is accompanied by her son, who informs you that she had a recent 10-day hospital stay for weakness. A CXR reveals an infiltrate in the left lower lobe.

The decision is made to initiate antimicrobial therapy for presumed healthcare-associated pneumonia. But, which antibiotics are safe to use in a patient with severe MG?

19 10, 2014

I am Dr. Ryan Radecki, author of EM Literature of Note: How I Work Smarter

By |October 19th, 2014|How I Work Smarter|2 Comments

How I Work Smarter LogoIn a previous How I Work Smarter post by Dr. Ken Milne, he called out Dr. Ryan Radecki, who is the outspoken and prolific author of EM Literature of Note and a premiere mythbuster in EM, specifically around thrombolytics in stroke. For those of us in the blogging world, not everyone knows that he lives a dual academic life working on medical informatics and information design. He is, in fact, funded through an NIH grant from the Agency of Healthcare Research and Quality for a training program in patient safety. Ryan shares his tips for working smarter.

16 10, 2014

Valproic Acid-Induced Hyperammonemic Encephalopathy

By |October 16th, 2014|Tox & Medications|2 Comments

Valproic AcidValproic acid is used for a variety of clinical indications including seizures, migraine prophylaxis and treatment, and bipolar disorder. A metabolite of valproic acid, thought to be propionic acid, has the ability to increase ammonia levels by inhibiting a step in the hepatic urea cycle, which may lead to valproic acid-induced hyperammonemic encephalopathy. As a result, patients treated with valproic acid presenting with signs and symptoms of acute mental status changes, increased seizure frequency, and/or gastrointestinal symptoms should be evaluated for elevated ammonia concentrations.

14 10, 2014

Blunt Chest Trauma: Validation of the NEXUS Chest Rule

By |October 14th, 2014|Expert Peer Reviewed (Clinical), Radiology, Trauma|4 Comments

Rib fx Chest CTWe commonly see patients who have some form of blunt chest trauma. This is the result of motor vehicle collisions, falls, and a myriad of other traumatic events. The decision to perform thoracic imaging can be difficult. Chest xray (CXR) and/or chest CT? In fact, studies have shown that emergency and trauma physicians often disagree 28-40.9% of the time about which patients require a chest CT following blunt trauma [1, 2].