A 6-year old boy has placed a hard bead in his ear and presents to the ED for care. How do you remove this foreign body as painlessly as possible? You can just barely see the edge of the bead by just looking at the external ear.
By experience, you know that mini-Alligator clips and forceps will not be able to sufficiently grab the edges of the bead. Additionally it may push the bead in even further.
How accurate is the clinical knee exam?
JAMA published a meta-analysis trying to answer this question. Although they include patients with acute and chronic knee pain, it’s a good general review of the knee anatomy, historical clues, and exam elements.
In the ED, the knee exam is challenging because we see very acute injuries where knee pain and swelling often preclude an accurate exam. For patients with an equivocal exam, be sure to refer for orthopedic follow-up. A repeat exam should be performed once the pain and swelling subside.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the Knee Exam.
I used to be all confused and had a hard time memorizing all the different maneuvers (especially for the meniscus). It is much easier to remember after doing these knee exams routinely. Particularly, the lateral pivot test and McMurray test can be done with several rounds of simultaneous knee flexion-extension, internal-external rotation, and valgus stressing. Looking at diagrams almost makes things more confusing.
Go to ALiEM (PV) Cards for more resources.
Hyperkalemia is a common presentation in the Emergency Department, especially in the setting of acute renal failure. In one shift, I had 4 patients with hyperkalemia! All had from some form of renal failure.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the treatment options for hyperkalemia.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Atraumatic subarachnoid bleeds are most commonly caused by ruptured intracranial aneurysms.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the current management, knowledge, and challenges in aneurysmal subarachnoid hemorrhage (SAH).
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Using the slit lamp can be a challenge to learn, especially if you haven’t seen pathology before. In checking for anterior uveitis (i.e. iritis), you need to look for “cell and flare”. In theory, you know that you are looking for inflammatory cells and “flare”, which resembles a light beam being filtered through smoke.
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Patients present with acute strokes to the Emergency Department. Time is of the essence to obtain a rapid neurologic exam, draw labs, get CT imaging, and consulting a neurologist especially if the patient presents within 3 hours of onset. To help the neurologist determine whether the patient should get thrombolytics, calculating a NIH Stroke Scale score is useful.w
In this installment of the Paucis Verbis (In a Few Words) e-card series, here is the NIHSS scoresheet.
| Score 0 | No stroke |
|---|---|
| Score 1-4 | Minor stroke |
| Score 5-15 | Moderate stroke |
| Score 16-20 | Moderate-severe stroke |
| Score 21+ | Severe stroke |
Go to ALiEM (PV) Cards for more resources.
Ankle fractures are a common injury diagnosed in the Emergency Department. Being able to speak Ortho-ese (i.e. the language of orthopedists) is invaluable in consulting the orthopedist over the phone. One ankle fracture classification system that our orthopedists like to use is the Lauge-Hansen system.
Go to ALiEM (PV) Cards for more resources.