Anticoagulant Reversal in Hemorrhagic Stroke
Acute management of cerebrovascular accidents can be challenging enough, but questions about anticoagulant reversal in the setting of hemorrhagic stroke add another layer of complexity. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with Dr. Joshua Goldstein (Massachusetts General Hospital, Harvard Medical School). Dr. Goldstein addressed common anticoagulants and their reversal agents, summarizing available literature to inform clinical practice. We present highlights from this discussion with Dr. Jason Woods. What is the goal of anticoagulant reversal? Since it is impossible to go back in time to prevent intracranial hemorrhage (ICH), the [+]
SplintER Series: A Collision at the Plate
A 17-year-old male baseball catcher presents with right knee pain after an opponent slid into home plate, striking the anteromedial aspect of the patient’s knee while it was in extension trying to block the plate. An x-ray of the tibia and fibula was obtained (courtesy of Dr. Haytham Bedier, Radiopaedia.org). This is a proximal avulsion fracture of the styloid process of the fibula, indicating injury to the posterolateral corner (PLC) of the knee [1]. Pearl: In most cases, the avulsed fragment is attached to the lateral collateral ligament and/or the biceps femoris [2]. This injury usually occurs [+]
SAEM Clinical Image Series: Red, White, & Blue
A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient developed pain and swelling of her right calf following a spider bite while putting on her pants. The patient felt a “burning pain” and found a spider which she then killed. She went to a hospital and received cephalexin, trimethoprim/sulfamethoxazole, and oxycodone. Despite taking these medications she continued having aching pain rated 10/10 in her right calf along with generalized pruritus. The patient stated that the bite evolved from an [+]
How I Work Smarter: Geoff Comp, DO
One word that best describes how you work? Deliberate Current mobile device iPhone 7 Computer MacBook Pro What is something you are working on now? I am working on a series of EM department recommendations for the treatment of various environmental conditions, including heat associated injury and hypothermia, with multiple residents interested in wilderness medicine. How did you come up with this Idea/Project? Like all great projects, these were developed while chatting about interests over beers! We reviewed current recommendations from various sources during a wilderness medicine interest group meeting and discovered the department does not have official guidelines [+]
SplintER Series: A Pain in the Elbow
A 12-year-old male pitcher for a traveling club baseball team complains of acute worsening of right elbow pain that has been bothering him for 3 months. The radiograph is shown below (Frontal elbow view. Case courtesy of Dr. Levente István Lánczi, Radiopaedia.org, rID: 46853). What is your diagnosis? What causes this injury? What patient demographic is most susceptible to this injury? How can this injury be prevented? What is the management of this injury in the Emergency Department? [+]
ACMT Toxicology Visual Pearls: “I have a nanging feeling about this”
Chronic exposure to which substance can cause this finding on a Cervical Spine MRI? Arsenic Carboplatin Nitrous Oxide Toluene [+]
Brian Lewis, MD
Corewell Health West - Butterworth Hospital
Grand Rapids, MI
Latest posts by Brian Lewis, MD (see all)
EM Match Advice: Residency Virtual Interviews in the COVID-19 Era
Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF), this podcast features program directors from esteemed residency programs on all things related to virtual residency interviews. [+]
Director of Growth, Strategic Alliance Initiative, Center [+]
Is it a Pneumothorax? An Unusual Post-Thoracentesis Radiograph
A 51-year-old female with a history of metastatic ovarian cancer on chemotherapy, malignant pleural effusions requiring repeat thoracentesis, and pulmonary embolism presented to the Emergency Department with worsening shortness of breath and dry cough. Upon arrival, she was hypoxic with an oxygen saturation level of 75% on room air. She was tachycardic, tachypneic, and her blood pressure was 125/56 mmHg. Labs revealed only a mild anemia (Hgb: 10.2). It was determined that her symptoms were secondary to recurrent right-sided malignant pleural effusions. Her presenting chest X-ray is pictured above (Image 1: Author’s own image). [+]
SAEM Clinical Image Series: Man vs Pneumatic Nail Gun
A 40-year-old male presents with injury to his left hand by a nail gun. While at work, the patient accidentally shot himself with a nail gun. The nail went through pneumatic air hose tubing, his third finger, and his thumb, keeping them all connected. He immediately felt uncomfortable in his left arm, and, upon arrival to the emergency department (ED), complained of swelling in his left arm extending to his neck. He feels shortness of breath and “fullness” in his throat. [+]
SAEM Clinical Image Series: Worsening Sore Throat
A 40-year-old male presented to the emergency department (ED) complaining of a sore throat for one week. The patient had presented ten days earlier following a stab wound to the anterior neck that violated the platysma. There was no vascular injury noted on the computed tomography angiography (CTA) but there was extensive soft tissue damage with emphysema extending into the retropharyngeal space. The patient underwent a flexible laryngoscopy by ENT, which showed no airway injury. He was observed in the intensive care unit for two days, then discharged. Following discharge, the patient had progressive sore [+]