Trick of the Trade: An Improvised Foreign Body Removal Device

Foreign bodies in the ear or the nose can be extremely challenging to remove, especially considering that a majority of them occur in children less than 7 years old who are likely to be uncooperative with exam [1]. In a previous post, we emphasized the need to pick the best tool for the job in order to minimize complications. What happens when you find yourself in an austere environment and the usual tools are not available?

(more…)

By |2020-04-14T12:40:35-07:00Apr 29, 2020|HEENT, Tricks of the Trade|

Guideline Review: Pre-exposure prophylaxis (PrEP) for HIV prevention

Pre-exposure prophylaxis of HIV (PrEP)While HIV medications receive much attention for the treatment of HIV infection, less attention has focused on the prophylaxis indications. In 2017, the Center for Disease Control and Prevention (CDC) updated their guidelines on the indications for the HIV medications tenofovir disoproxil fumarate (TDF) and emtricitabine (2′,3′-dideoxy-5-fluoro-3′-thiacytidine, FTC) for pre-exposure prophylaxis (PrEP). The trade name for the combination medication is Truvada. These daily medications are taken by people at risk for HIV to prevent HIV. This Guideline Review succinctly summarizes the 77-page CDC document into the key pearls for emergency physicians.

(more…)

IDEA series: The Bleeding Arm Tourniquet Simulation

Tourniquet simulation

Education in emergency response to trauma is a global health priority [1]. Mortality rates are nearly twice as high in patients with trauma in low-income as compared to high-income countries [2]. With uncontrolled bleeding as the number one cause of death from trauma, tourniquet application has been the focus of training programs, like the “Stop the Bleed” campaign in the United States [3]. Although understanding how to apply a tourniquet is a life-saving intervention, use of a windlass tourniquet may not be intuitive [4].  The windlass tourniquet in its simplest form is the “stick-and-rope.” Winding the stick in the tourniquet creates a mechanical advantage for providing compression. Simulation of the windlass technique can be used to teach management of uncontrolled bleeding. Here we describe a low-cost simulation model that combines low- and high-fidelity techniques to train healthcare personnel on windlass tourniquet application.

(more…)

A Tale of Two Epidemics: COVID-19 and the Opioid Crisis

The United States is currently dealing with 2 deadly, concurrent epidemics: COVID-19 and the opioid crisis. Both need viable solutions. The better we are equipped to address one, the more effective we can be at treating the other. Counterintuitively, now is actually the best time to get waivered. It’s imperative that we do so for 3 reasons:

(more…)

Diagnose on Sight: Scrotal Swelling

pneumoscrotum

Case: A 58-year-old male with no past medical history presents to the emergency department for evaluation of right lower quadrant abdominal pain associated with right scrotal swelling. The patient reports that he had a colonoscopy the day before to remove a 20 mm polyp, which had been seen on an outpatient CT scan. He states that he noticed that his right scrotum appeared slightly swollen immediately away after the procedure, but since then the swelling had increased and he developed mild right lower quadrant abdominal pain. Physical examination reveals mild tenderness to the right lower quadrant and swelling of the right scrotum with palpable crepitus of the right scrotum and inguinal canal.  There is no overlying skin discoloration.  What is the most likely diagnosis?

(more…)

LVAD Part V: The Coding LVAD Patient

Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart failure. Although their use in the general public has increased, they still provide a challenge to the emergency medicine (EM) physician. This series aims to cover the basics of how the EM physician approaches the care of these patients.

(more…)

By |2020-04-20T09:48:07-07:00Apr 20, 2020|Cardiovascular, Emergency Medicine|

A Pop in the Calf – Plantaris Rupture

plantaris rupture

A 32 year-old male presents to the Emergency Department after he felt a “pop” in his posterior-medial calf while playing tennis. He was able to ambulate but had pain with plantar flexion and was unable to continue playing tennis. What is your differential diagnosis? What physical exam maneuver would you perform? What findings would you expect on physical exam? What is the diagnosis based on ultrasound images? What is your management in the emergency department?

(more…)