EMRad: Radiologic Approach to the Pediatric Traumatic Elbow X-ray
This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the adult elbow, here we will cover the approach to the pediatric elbow. Learning Objectives Interpret traumatic pediatric elbow x-rays using a standard approach Identify clinical scenarios in which an additional view might improve pathology diagnosis Why the pediatric elbow matters and the radiology rule of 2’s The Pediatric Elbow 10% of [+]
SplintER Series: Venous Thoracic Outlet Syndrome
A 29-year-old male presents with right shoulder pain, throbbing, and swelling. He states that a bulge has appeared over his right anterior shoulder recently (Image 1). While he was doing pushups today, he began to have numbness, tingling, and weakness in his right arm. While in the waiting room, his symptoms have completely resolved. Image 1: Bedside ultrasound of the anterior shoulder at the site of the bulge. AA=axillary artery. AV=axillary vein. Author’s image. [+]
Does the Combination of Parenteral Olanzapine with Benzodiazepines for Agitation in the ED Increase the Risk of Adverse Events?
A previous EM Pharm Pearl focused on the adverse events associated with the use of IV olanzapine for agitation. This pearl addresses concerns around using parenteral (IV or IM) olanzapine with parenteral benzodiazepines. Background Olanzapine has two FDA boxed warnings, one for increased mortality when used long-term in older adults with dementia-related psychosis and another pertaining to adverse effects of extended release IM olanzapine. However, there exists a potential risk of excess sedation and respiratory depression when IM/IV olanzapine is administered with parenteral benzodiazepines for agitation. The European Medicines Agency recommends separating the administration of IM/IV olanzapine and parenteral benzodiazepines [+]
How I Work Smarter: Molly Estes, MD, FACEP, FAAEM
One word that best describes how you work? Efficiently Current mobile device iPhone 11 Pro Computer MacBook Air What is something you are working on now? This survey :) In seriousness, trying to complete a survey-based study on the effects of virtual rotations on the 2020-21 EM application cycle. How did you come up with this Idea/Project? This idea was generated by a subcommittee I am a part of through the Advising Students Committee in EM (ASCEM) through CORD. After brainstorming about the effects that the required conversion to virtual rotations might have had on this year's students applying into [+]
SplintER Series: A Case of Arm Pain
An 80-year-old male presents with severe right arm pain after he tripped and fell down 2 steps. Examination shows deformity and swelling to his right upper arm. You obtain AP and lateral humerus x-rays as above. [+]
Computerized Adaptive Screen for Suicidal Youth (CASSY) study
Adolescent suicide rates in the United States, partly augmented by the COVID-19 pandemic, are steadily increasing [1, 2]. A commonly used screening tool is the 4-question Ask Suicide-Screening Questions (ASQ) instrument, which has a sensitivity and specificity of 60% and 92.7%, respectively, in predicting suicide-related events within 3 months. This was derived from a retrospective study of 15,003 pediatric patients (age 10-18 years) [3]. Given the morbidity and mortality associated with suicide attempts, is there a better screening tool with a higher sensitivity than 60%, while also maintaining adequate specificity? A higher sensitivity rate ensures that we have fewer misses. [+]
SplintER Series: Keep Your Knees Up
A 27-year-old female presents with left knee pain after a low-speed motor vehicle collision in which her knee hit the dashboard. She is tender over the patella without significant effusion and has an intact extensor mechanism. The above x-ray was obtained (Image 1. X-ray left knee. Case courtesy of Dr. M. Mourits, Radiopaedia.org, rID: 14476). [+]
How I Work Smarter: Rodney Fullmer, DO, MBS
One word that best describes how you work? Passionately Current mobile device Samsung Galaxy 9 (sorry not an apple/mac guy) Computer PC- Dell XPS What is something you are working on now? I am working on two very cool education projects right now within our ED. I am creating a new curriculum for our senior ED residents at Swedish called MastER's Class. The curriculum aims to prepare senior ED residents for life post-residency; looking at everything from contracts, litigation, finances, wellness, the business side of EM, job opportunities outside of the ED, and many more. Resident T-ED talks. Swedish ED [+]
SplintER Series: A Temporary Pain in the Neck
An 18-year-old football player presents to the Emergency Department after an episode of transient numbness, tingling, and inability to move his right upper extremity after making a tackle. He continued playing without recurrence. The above imaging was obtained (Figure 1. Lateral cervical spine x-ray. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 32505). [+]
SAEM Clinical Image Series: What’s This Thing on My Face?
A 91-year-old female patient presented with her family after concern for multiple new lesions on her face and hands. The patient thinks the lesions grew over the course of a few months. There is no pain at the sites, no erythema, and no pruritis. She has caught the lesions on clothing and bedding, which has irritated the lesions on occasion, and the family is concerned/embarrassed by the growths on her face, which are harder to conceal than those on her hand. [+]