Can you see the pneumothorax?
Small pneumothoraces can be difficult to detect on chest xrays. Overlying ribs, other bony structures, and soft tissue can obscure subtle findings. For a patient at risk for a small pneumothorax, you can use your digital radiology PACS system to improve your ability to spot them.
Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis.
Where does the American College of Emergency Physicians (ACEP) stand on the critical issues surrounding the evaluation of appendicitis?
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the ACEP Clinical Policy on Appendicitis. In the end, the policy conjures up more questions than answers, but a comprehensive presentation of the literature to date and helpful risk-stratification data are provided.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
How do you approach the repair of scalp lacerations in a child? What factors are you considering?
This trick of the trade pearl addresses the stapling technique for scalp laceration repair. Perhaps the child’s hair is too short for the HAT trick.
In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.
I was surprised to learn that only about 50% of patients with septic joints have a fever. Note that a hip or knee prosthesis PLUS an overlying skin infection pretty much equals a septic joint (LR = 15.0).
Risk factors are listed in the table with the corresponding sensitivities, specificities, and likelihood ratios.
Go to ALiEM (PV) Cards for more resources.
I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc.
There are some things in life which I just can’t memorize and dermatomal/myotomal maps are one of them. Weird cases of peripheral neurologic symptoms have presented to the ED in the setting of trauma and no trauma. So purely for selfish reasons, I’m making my own map to have on file.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews Sensory and Motor Function Testing by Levels.
Does your endotracheal tube get caught up on a swollen or floppy epiglottis during insertion?
Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.