Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?
Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur in up to 30% of cancer patients at some point during the disease.1–3 Clinical manifestations include mental status changes (which may progress to coma) and renal impairment.3 These patients may be classified based on both type and severity. Therapies for managing MAH emergently should focus on correcting the underlying mechanism, as outlined below with their respective causes:3 [+]
Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?
The 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (SSTI) recommend sulfamethoxazole-trimethoprim (SMX-TMP) for purulent infections where methicillin-resistant S. aureus (MRSA) is a likely pathogen. 1 But, what dose of SMX-TMP should we be prescribing? Both the SSTI and MRSA guidelines say 1-2 double strength tablets twice a day. 1,2 So, which is it, 1 tablet or 2? [+]
Ultrasound For The Win: 22M with Scrotal Pain #US4TW
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 22-year-old man presents with acute scrotal pain. [+]
PV Card: Focused Echocardiography Ultrasound
So many great information can be gleaned from a focused echocardiogram in Emergency Department patients. What views are you obtaining? What is the importance of the e-point septal separation (EPSS) and how to measure this? Drs. Jimmy Fair, Mike Mallon, and Mike Stone provide a terrific step-by-step image-based guide to these questions that you can use at the bedside as a refresher. PV Card: Focused Echocardiography Ultrasound Adapted from [1, 2] References Randazzo M, Snoey E, Levitt M, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. [+]
Trick of the Trade: L5 medial hamstring reflex
Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex. [+]
Sepsis in Older Adults: The Presentation May Be Subtle
60% of patients in the United States who develop severe sepsis are older adults (age 65 and over) [1], and the mortality of severe sepsis increases steadily with age to nearly 40% in those over 85 [2]. There are many factors that make older adults more susceptible to sepsis, and that can also make sepsis more difficult to detect. Here are some tips to help explain why this is, and how you can identify it sooner. [+]
PV Card: Focused Lung Ultrasound
Bedside pulmonary ultrasonography is becoming increasingly popular in the Emergency Department. You can you use it to assess for pneumothoraces, pleural effusion, pneumonia, pulmonary edema, and other etiologies. There are subtle nuances to help you differentiate these diagnoses. What are A-lines and B-lines? This PV card on the focused lung ultrasound by Drs. Anne Aspler, Clare Heslop, and Mike Stone outline some great bedside tips. PV Card: Focused Lung Ultrasound Adapted from [1–3] References Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849. [PubMed] Liteplo A, Marill [+]
PV Card: Pericarditis – Diagnosis and Treatment Recommendations
When the topic of pericarditis is mentioned, the classic electrocardiogram (ECG) findings of diffuse ST elevation and PR depression are often the focus of discussion. What about the criteria for diagnosis, the 3-prong approach to treatment, and contraindications to colchicine? These are the great questions answered by Dr. Chris Bond (@socmobem) in this PV card, which summarize 3 key papers by Imazio et al from the New England Journal of Medicine, Archives of Internal Medicine, and Circulation. PV Card: Pericarditis - Diagnosis and Treatment Read more ALiEM (PV) Cards.
PV Card: Focused Ocular Ultrasound
Ocular injuries and pathology are a common cause for Emergency Department visits. With bedside ultrasonography, many of these conditions can be assessed. Did you know that you can check for a retinal detachment, vitreous hemorrhage, and even a lens dislocation? What do these look like? Check out this great PV card on the focused ultrasound assessment of the eye. PV Card: Ocular Ultrasound Adapted from [1, 2] Go to ALiEM (PV) Cards for more resources. References Blaivas M, Theodoro D, Sierzenski P. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002;9(8):791-799. [PubMed] Kimberly H, [+]
Diagnose on Sight: Traumatic low back pain
Case: An 18 year old female was the restrained passenger in a motor vehicle crash moving at 65 mph. She complained of traumatic low back pain radiating to her abdomen. What is the most likely mechanism of injury, based on this video of CT images? [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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