Author: Ryan Circh, MD
- A “shoulder separation” is when the clavicle separates from the scapula – also referred to as an acromio-clavicular (AC) separation
- Diagnosis is clinical: pain over AC joint, pain with adduction, and difficulty raising harm past horizontal
- Early range of motion can be critical for recovery
Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med. 1998 Jan-Feb;26(1):137-44. Review. PubMed PMID: 9474415.
Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute Shoulder Injuries in Adults. Am Fam Physician. 2016 Jul 15;94(2):119-27. Review. PubMed PMID: 27419328.
Author: Sam Killian, MD
- MRI machines can generate enough heat from the radiofrequency to cause thermal burns
- Patients with EKG stickers, medication patches, clothing impregnated with metallic ions, etc., can all increase risk of burns
- Even skin-to-skin contact within the patient can cause a misinterpretation from the software and increased energy, leading to burn
Cross NM, Hoff MN, Kanal KM. Avoiding MRI-Related Accidents: A Practical Approach to Implementing MR Safety. J Am Coll Radiol. 2018 Aug 24. pii: S1546-1440(18)30762-2. doi: 10.1016/j.jacr.2018.06.022. [Epub ahead of print] PubMed PMID: 30149951.
Takahashi T, Fujimoto N, Hamada Y, Tezuka N, Tanaka T. MRI-related thermal injury due to skin-to-skin contact. Eur J Dermatol. 2016 Jun 1;26(3):296-8. doi: 10.1684/ejd.2016.2740. PubMed PMID: 26987101.
Pietryga JA, Fonder MA, Rogg JM, North DL, Bercovitch LG. Invisible metallic microfiber in clothing presents unrecognized MRI risk for cutaneous burn. AJNR Am J Neuroradiol. 2013 May;34(5):E47-50. doi: 10.3174/ajnr.A2827. Epub 2011 Dec 15. PubMed PMID: 22173750.
Dempsey MF, Condon B. Thermal injuries associated with MRI. Clin Radiol. 2001 Jun;56(6):457-65. Review. PubMed PMID: 11428795.
Author: Ryan Circh, MD
- Review of 25 randomized control trials encompassing 16,037 acutely ill hospitalized patients
- Patients given oxygen with saturations > 94% on room air were found to have associated increased mortality in-hospital, at 30-days, and at long-term follow up
- It may seem intuitive, but do not give oxygen to patients that do not need it
Chu DK, et al (2018). Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 391(10131):1693-1705
Author: Michael Hunt, MD
- Use the mnemonic NOT RECLUSE to rule out a brown recluse spider bite:
- Numerous bites (recluse spiders will bite once)
- Occurence (recluse bites between April- October)
- Timing (recluse spiders are… get this… reclusive)
- Red (recluse bites are white/pale)
- Elevated (recluse bites are flat)
- Chronic (recluse bites are acute)
- Large (recluse wounds are small)
- Ulceration, early (recluse bites ulcerate between 7-14 days)
- Swollen (recluse bites are flat)
- Exudative (recluse bites are dry)
Stoecker WV, Vetter RS, Dyer JA. NOT RECLUSE-A Mnemonic Device to Avoid False Diagnoses of Brown Recluse Spider Bites. JAMA Dermatol. 2017 May 1;153(5):377-378. doi: 10.1001/jamadermatol.2016.5665. PubMed PMID: 28199453.
Check out this episode!
Author: Nick Tsipis, MD
- Persistent fever or positive blood cultures should raise suspicion for endocarditis
- Patients with recent dental procedures, recent cardiac surgeries are at risk, or who inject drugs are at higher risk
- Physical exam findings may include fever with a new murmur, Janeway lesions, Osler nodes, and/or splinter hemorrhages
Long B, Koyfman A. Infectious endocarditis: An update for emergency clinicians. Am J Emerg Med. 2018 Sep;36(9):1686-1692. doi: 10.1016/j.ajem.2018.06.074. Epub 2018 Jul 2. Review. PubMed PMID: 30001813.
Murdoch DR, Corey GR, Hoen B et. al. International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009 Mar 9;169(5):463-73. doi: 10.1001/archinternmed.2008.603
- Blood concentrations over 0.4 mg/dL is associated with respiratory depression and possible death in alcohol naive patients
- Alcohol overdose accounts to 2,200 deaths per year
- Don’t forget about checking for hypoglycemia in severe alcohol intoxication
- Consider ketamine for agitation to prevent further respiratory depression
Editor’s note: check out our podcast on ketamine for alcohol withdrawal here
Jung YC, Namkoong K. Alcohol: intoxication and poisoning – diagnosis and treatment. Handb Clin Neurol. 2014;125:115-21. doi: 10.1016/B978-0-444-62619-6.00007-0.
Centers for Disease Control and Prevention (CDC). “Vital signs: binge drinking prevalence, frequency, and intensity among adults-United States, 2010.” MMWR. Morbidity and mortality weekly report 61.1 (2012): 14.
Author: Jared Scott, MD
- Blood at urethral meatus in trauma can be a sign of bladder/urethral injury
- Blind placement of a Foley catheter can make an undiagnosed urethral injury worse
- Urethral injury is evaluated using a retrograde urethrogram (RUG)
- If urethra is confirmed to be intact, Foley catheter can be placed to allow additional tests
Avery, L. (2012). Imaging of male pelvic trauma. Radiologic Clinics of North America., 50(6), 1201-1217.
Author: Sue Chilton, MD
- An unusual cause of leg pain that can mimic sciatica/claudication
- Predominantly occurring in high endurance athletes, particularly cyclists and runners
- Check supine ABIs 1 minute after activity in the ED: a value < 0.5 is 80% sensitive
Mansour A, Murney S, Jordan K, Laperna L. Endofibrosis: an unusual cause of leg pain in an athlete. J Sports Med Phys Fitness. 2016 Jan-Feb;56(1-2):157-61. Epub 2015 Jul 3. PubMed PMID: 26140352.
Peach G, Schep G, Palfreeman R, Beard JD, Thompson MM, Hinchliffe RJ. Endofibrosis and kinking of the iliac arteries in athletes: a systematic review. Eur J Vasc Endovasc Surg. 2012;43(2):208–17.