Geriatric Blunt Trauma – Respect the Lactate

Which is a better prognostic tool in geriatric trauma, traditional vital signs or lactate level?

Meet Norma Nuance (NN), a 70-year-old woman with CAD, HTN, HLD, DM, and mild dementia. She was involved in an MVC as the restrained driver with questionable LOC. She arrives in your ED and appears confused, but has a history of dementia. There are no family members to tell you her baseline. Her BP is 120/80, and her HR is 90. She is not calling out in pain, but does mumble about her left arm when you ask if she is hurting. You think she may have sprained her wrist.

Now meet Frankie Obvious (FO), a 22-year-old male, who was the helmeted driver of a motorcycle that hit a car. He was thrown from the motorcycle, and arrives combative and yelling with a HR of 130 and a BP of 100/70.

Based on their vital signs, which patient is going to receive more immediate attention? Your lactate level is pending… (more…)

By Christina Shenvi, MD, PhD, MBA|2017-03-05T14:18:36-08:00Jul 1, 2013|Geriatrics, Trauma|

Welcome new series Geriatric EM by Dr. Christina Shenvi

Welcome a new superstar blogger, Dr. Christina Shenvi (@clshenvi), to the ALiEM team. If there’s one talent I have, it’s spotting the rising academic star. As the new Geriatrics EM fellow at the University of North Carolina, she’ll be starting her monthly series of blog posts on Geriatric EM. I jumped at the chance when she came up with the idea of this series, since there is never enough teaching about the unique aspects in the emergent care of older patients. Since meeting her in March 2013 at the annual CORD meeting, it’s been the longest 4 months anxiously waiting (and waiting, and waiting) for her to start her Geriatric EM fellowship and contributing blog articles.

(more…)

By Michelle Lin, MD|2019-01-28T21:58:18-08:00Jul 1, 2013|Geriatrics|

Patwari Academy videos: Anticoagulation and reversal agents

Bleeding in general is bad. Bleeding while on anticoagulants is VERY bad. Dr. Rahul Patwari reviews the pathophysiology of coagulation, the various reversal agents, and treatment approaches we can use. In this five-part series where all videos are less than 10 minutes, Rahul goes from the basic physiology of coagulation all the way to the complex reasoning and approaches to reversing anticoagulants. These are worth a quick look and review.

(more…)

By Michelle Lin, MD|2019-01-28T21:57:58-08:00Jun 30, 2013|Heme-Oncology, Patwari Videos, Tox & Medications|

The Dirty Epi Drip: IV Epinephrine When You Need It

You’re a recent graduate picking up an extra shift in a small ED somewhere north of here. At 3 AM an obese 47 year-old woman presents with shortness of breath and difficulty speaking after eating a Snickers bar an hour earlier. She admits to history of hypertension, peanut allergy, and a prior intubation for a similar presentation. She is becoming more obtunded in the resuscitation room as you are collecting your history. A glance at the monitor shows:

HR 130
BP 68/40
O2 saturation 89% on room air

(more…)

By Zlatan Coralic, PharmD|2021-02-01T09:19:17-08:00Jun 27, 2013|Allergy-Immunology, Tox & Medications, Tricks of the Trade|

Brugada Syndrome is an abnormal ECG (Right Bundle Branch Block Pattern with coved ST elevation over the right precordial leads of V1-V3), which leads to ventricular fibrillation (VF) and sudden cardiac death (SCD) in patients with structurally normal hearts. It has been recognized as a clinical entity since 1992. Why should all ED physicians know about this entity? Although a rare syndrome, it is often mistaken as a STEMI and more importantly the clinical spectrum can be asymptomatic to SCD.

(more…)

By Salim Rezaie, MD|2019-11-24T14:50:26-08:00Jun 26, 2013|Cardiovascular, ECG|

Trick of the Trade: Got a shoulder dislocation? Park it

ShoulderDLxray

Myriad techniques exist to reduce shoulder dislocations, which includes scapular rotation, Hennepin, Snowbird, Cunningham, and Legg maneuvers. They are nicely reviewed at ShoulderDoc.co.uk. You can also supplement any technique with ultrasound-guided intraarticular lidocaine for improved pain control.

Recently, Dr. Jay Park (Beth Israel Medical Center in New York) contacted me about his novel approach to shoulder reduction which anatomically makes sense. If his animation video doesn’t convince you, check out the video of an actual reduction.

(more…)

By Michelle Lin, MD|2019-01-28T21:59:02-08:00Jun 25, 2013|Orthopedic, Tricks of the Trade|

Anterior Shoulder Dislocation: Are Prereduction Films Needed?

A patient comes into your department with an obvious shoulder dislocation. You know you can easily reduce the shoulder and have the patient discharged before the orthopedic consultant calls back. But what if there is a fracture? Do you need to get that plain film before popping it back into place?