Case: An 18 year old female was the restrained passenger in a motor vehicle crash moving at 65 mph. She complained of traumatic low back pain radiating to her abdomen. What is the most likely mechanism of injury, based on this video of CT images?
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.
“Time is testicle.” Every minute drags by while you are awaiting your ultrasonographer to arrive to scan your patient to rule out testicular torsion. Why not take a quick look yourself? What are you looking for? This is an excellent PV card by Drs. Matthew Dawson and Mike Stone on the topic of testicular ultrasound, giving the basics about testicular torsion and acute epididymitis.
Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.
There is so much literature to sift through each year, it becomes nearly impossible to stay abreast of it. Here is a quick summary of the 6 must-know Emergency Medicine pharmacotherapy articles from 2014, in my humble opinion.
“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
A patient comes into the ED and you suspect septic arthritis to the knee. As you consent the patient for arthrocentesis, you can tell s/he has reservations about a needle being inserted into their knee and left in place while you aspirate. You also think in the back of your mind how tricky it is to sometimes change syringes while keeping the needle in the correct location. Is there another way of tapping the knee without a needle?
We know that ultrasonography can be used to identify soft tissue infections. But what exactly are the distinguishing features between cellulitis and abscess? Is that a foreign body? Should I put a scalpel to this soft tissue infection? This PV card, written by Drs. Alissa Genthon, Patricia Henwood, and Mike Stone, serves as a great reference card for you at the bedside.
Go to ALiEM (PV) Cards for more resources.