High risk back pain: Spinal Epidural Abscess

Spinal epidural abscess (SEA) is a rare but potentially catastrophic cause of back pain. Classically these patients are described as having back pain, fever, and clear neurologic deficits. In reality, patients often present with less obvious symptoms which often leads to a delay in diagnosis. Missed cases of SEA are a source of significant risk to both the patient and the provider. To improve outcomes and minimize risk, providers must identify and promptly evaluate patients who are at increased risk of developing a SEA.

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By Matthew DeLaney, MD|2016-11-12T09:28:24-08:00Sep 25, 2014|Infectious Disease, Orthopedic|

Diagnose on Sight: “I feel like I am having a heart attack”

Case: A 18-year-old male with no medical history presents to the emergency department (ED) complaining of “feeling like I am having a heart attack” which started suddenly 1 hour ago. The patient ate from a food truck the night before and developed several episodes of forceful vomiting prior to arrival in the ED. What finding in this supine chest radiograph aids in the diagnosis? Click on image for a larger view.

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By Nikita Joshi, MD|2016-12-22T19:15:42-08:00Sep 23, 2014|Diagnose on Sight, Pulmonary, Radiology|

Vomiting in Kids After Head Trauma: To CT or Not to CT?

A 6-year-old male is brought to the emergency department (ED) after falling from the monkey bars at a local playground. Physical examination reveals no scalp hematoma, and the child appears alert and well oriented. You decide to observe him over the next 30 minutes hours to determine if he develops any disconcerting symptoms. After 15 minutes of observation within the ED the patient has an episode of vomiting witnessed by the nurses. The patient’s mother wants to know if this means he has failed his observation period and needs to receive a head CT. Your answer? (more…)

By William Paolo, MD|2016-12-16T12:06:29-08:00Sep 18, 2014|Pediatrics, Trauma|

Antidiabetic Medications: Hypoglycemic Potential in Overdose

With several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class. ¹

Keep in mind that other drugs can interact with antidiabetic medications resulting in hypoglycemia. The following table applies only to single agent ingestion/administration.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:22:28-08:00Sep 16, 2014|Endocrine-Metabolic, Tox & Medications|

PV Card: Focused Abdominal Aorta Ultrasound

In this next ultrasound installment in the PV Card series, Drs. Victoria Koskenoja, Heidi Kimberly, and Mike Stone succinctly summarize the focused abdominal aorta ultrasound to assess for an abdominal aortic aneurysm (AAA). These can serve as key reference cards when you do your next AAA scan. Don’t miss the last card with tips on optimizing the view and common pitfalls.

PV Card: Focused Abdominal Aorta Ultrasound

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-06T10:07:34-07:00Sep 13, 2014|ALiEM Cards, Cardiovascular|

PV Card: FAST Ultrasound

Keeping in line with the recent ultrasound posts this month, Dr. Mike Stone’s star team is releasing a series of Paucis Verbis cards on the basics of bedside ultrasonography. Here is the first in the series on the Focused Assessment with Sonography in Trauma (FAST) by Drs. Wilma Chan, John Eicken, and Mike Stone.

PV Card: FAST Ultrasound

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-06T10:09:27-07:00Sep 12, 2014|ALiEM Cards, Ultrasound|

US4TW Case: 28F with Shortness of Breath

Welcome to the inaugural post for an exciting new ultrasound-based case series called “Ultrasound For The Win!” (#US4TW). In this peer-reviewed case series, we will focus on real clinical cases where bedside ultrasound changed the management or aided in the diagnosis. In our first case, we present a 28-year-old female with shortness of breath.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:09:13-07:00Sep 11, 2014|Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Pulmonary, Ultrasound, Ultrasound for the Win|