Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex.
Anti-NMDA-receptor encephalitis is a severe and treatable immune-mediated disorder which presents with a rapid progression of psychiatric and neuropsychiatric symptoms. Although only first reported as a diagnosis in 2007, an exponential number of cases have since been described, suggesting that the disease is not rare but rather under-diagnosed. Emergency physicians play an important role in recognizing this disorder, as prognosis is largely dependent on early treatment with immunotherapy.
“Looking back at this time, I see that I’d begun to surrender to the disease, allowing all the aspects of my personality that I value – patience, kindness, and courteousness – to evaporate. I was a slave to the machinations of my aberrant brain. We are, in the end, a sum of our parts, and when the body fails, all the virtues we hold dear go with it.” – Brain on Fire, Susannah Cahalan
We are very excited this month to bring you our second Global Journal Club, co-hosted by the team here at ALiEM and the editorial board at the Annals of Emergency Medicine. This month, we are changing things up! We will be providing you, our readers, with a clinical vignette and related journal club questions today at the beginning of the week.The discussion will be held asynchronously starting today through Thursday (for 4 days). Respond by blog comment below or tweet (#ALiEMJC).
On Wednesday, January 22, 2014 at 11 am PST (2 pm EST), we will be hosting a 30-minute live Google Hangout with Drs. Jeff Perry and Ian Stiell. The video will be embedded on this page. During this period, you will be able to tweet by using the #ALiEMJC hashtag and post comment in the blog comment section below.
To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.
Ischemic stroke is an emergent and devastating neurologic disorder, and is a leading cause of both death and disability in the United States. With each minute of brain ischemia, two million neurons are irreversibly damaged. Total ischemic time is linked to functional outcome, and therefore, the role of the Emergency Department is paramount in the management of these patients. Fibrinolytic therapy has become a mainstay of therapy for acute stroke, but guidelines for the use of tPA are dynamic, and often even controversial. When you identify someone with symptoms of stroke, what is your approach to determining if a patient should receive tPA?
You are in the ED when a 7 month old is brought in by EMS after a witnessed generalized seizure. The grandmother reports that the child has had URI symptoms for a couple of days and then developed a fever today. Shortly after giving ibuprofen, the child began to seize with arms and legs twitching. The episode lasted approximately 8 minutes and when EMS arrived, the child was sleepy, but arousable. The glucose was 92 mg/dL en route. On exam in the ED, child is awake and staring at you to make the next move…
Vitals: Temp 39C, P 136, RR 28, Sat 100%