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23 09, 2011

Paucis Verbis: Does this DM leg ulcer have osteomyelitis?

2017-08-01T23:30:55+00:00

DMfootulcerWe sometimes see diabetic patients in the ED for a worsening foot ulcer. Sometimes it’s the chief complaint. Other times, however, you just notice it on physical exam. So, be sure you examine the feet of your diabetic patients. Occasionally, you’ll be surprised by what you find.

Several questions come up with diabetic foot ulcers:

  • Is it a true diabetic foot ulcer, or is it an arterial or venous insufficiency ulcer?
  • Is there underlying osteomyelitis?
  • How can I best diagnostically work this foot ulcer up for osteomyelitis?
  • What is the Wagner grade of this ulcer? (I think it’d be Grade 2.)

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5 08, 2011

Paucis Verbis: Spinal epidural abscess

2017-08-03T00:29:11+00:00

afp20020401p1341-f2One of the most challenging diagnoses to make is that of a spinal epidural abscess (SEA), especially if you work in an Emergency Department which cares for many IV drug users and HIV patients. There’s never before been a published diagnostic guideline or algorithm which helps you with risk-stratification.

In the Journal of Neurosurgical Spine, a diagnostic guideline was prospectively evaluated on a small population (n=31) as compared to historical controls (n=55). They found that an ESR test had a sensitivity of 100% if a patient had at least 1 risk factor for SEA. A CRP test was much less helpful.
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1 04, 2011

Paucis Verbis: Post-exposure prophylaxis (non-occupational)

2019-01-28T22:55:24+00:00

HIVPEP

You know how chief complaints present to the ED in multiples? In one week, I had several cases where patients were asking for post-exposure prophylaxis treatment NOT in the content of a sexual assault. I haven’t had to manage such cases in a long time and so needed to look up the recent guidelines from the CDC.1

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16 03, 2011

Trick of the Trade: Topical anesthetic cream for cutaneous abscess drainage in children

2016-11-11T18:58:14+00:00

AbscessDiagramAbscess drainage can be painful and time consuming in the ED. Can this article help? 1

Trick of the Trade

Apply a topical anesthetic cream on skin abscesses prior to incision and drainage (I and D).

In this press-released article in American Journal of Emergency Medicine, the authors found that application of a topical 4% lidocaine cream (LMX 4) was associated with spontaneous cutaneous abscess drainage in children.

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16 02, 2011

Trick of the Trade: Serial lactate measurements in sepsis?

2019-01-28T23:05:12+00:00
SepsisDoes your Emergency Department have computerized spectrophotometric catheters to measure continuous central venous oxygen saturation (ScvO2) in early goal directed therapy (EGDT) for severe sepsis? That’s what was used in the original Rivers’ EGDT study.

I’ve never even seen one before.

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9 02, 2011

Trick of the Trade: Conveying risk for postexposure prophylaxis

2016-11-11T18:59:30+00:00

NeedlesA health care worker hurried in to the ED after being poked with a needle.

‘It was an old 18G needle with dried blood’, she said. Her puncture had drawn blood. You discussed the very low risk of contacting HIV and the side effects of postexposure prophylaxis (PEP). She asked, ‘What does very low risk mean?’

Is there another way to covery risk for patients?

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