Transient Synovitis vs Septic Arthritis of the Hip

Limping is a common reason for parents to bring their children to emergency departments. It is known that 77% of acute, atraumatic limp is dealt with in the ED, and 20% do not even complain of pain.¹ Our job as physicians is to complete appropriate assessments to not miss any serious pathology. Specifically, differentiating between transient synovitis (TS) and septic arthritis (SA) of the hip can be difficult and frustrating for everyone. What is your approach?

(more…)

By Salim Rezaie, MD|2019-09-10T13:38:27-07:00May 1, 2013|Orthopedic, Pediatrics, Radiology|

Trick of the Trade: Urine Collection in Neonates

The Case: A 8-day-old, uncircumcised male is brought to the ED with fever, irritability, and decreased urination.

The Problem: Getting a clean catch urine in a timely, non-invasive manner

The Solution?

(more…)

By Salim Rezaie, MD|2016-11-11T18:38:43-08:00Apr 30, 2013|Genitourinary, Pediatrics, Tricks of the Trade|

The SCRAP Rule: Indications for chest CT in blunt trauma

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLarger At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 ¹ looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment.

(more…)

By Salim Rezaie, MD|2019-09-10T13:38:17-07:00Apr 25, 2013|Radiology, Trauma|

Trick of the Trade: Making the NG and NP procedures less painful

When doing nasogastric (NG) tubes and fiberoptic nasopharyngoscopy (NP) procedures, there many approaches in how patients can be locally anesthetized. Getting things pushed up your nose is so profoundly irritating that most patients only give you 1 or 2 changes to get it right.

One option is to use nebulized lidocaine, although it takes a while to prepare and anecdotally tends to numb mainly the hypopharynx, placing the patient at risk for aspiration later on. Another option is to use viscous lidocaine to coat the NG or NP tubing, but this is fairly messy and only mildly helpful. Commercial intranasal atomizers, which disperse lidocaine over the nasal mucosal surfaces well, are generally effective, but may not be available in some emergency departments.

(more…)

By Michelle Lin, MD|2019-02-22T13:34:02-08:00Apr 23, 2013|Tricks of the Trade|

Patwari Academy video: Altered mental status

Get an organized approach on the broad chief complaint of “Altered Mental Status”. Learn about the AEIOU TIPS mnemonic om this 20 minute video by Dr. Rahul Patwari.

(more…)

By Michelle Lin, MD|2019-01-28T22:00:05-08:00Apr 21, 2013|Patwari Videos|

Management of Syncope

“Done Fell Out”, or DFO, is a common saying in the South to describe syncope. Although the saying is funny the diagnosis is not. Syncope accounts for about 3–5% of ED visits and 1–6% of hospital admissions. In patients >65, syncope is the 6th most common cause of hospitalization.

How do you approach the management of patients with syncope?

(more…)

By Salim Rezaie, MD|2019-09-10T13:38:10-07:00Apr 18, 2013|Cardiovascular|