Author: EMMadmin

Podcast #382: Shoulder Separations

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Author:  Ryan Circh, MD

Educational Pearls:

  • 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

References:

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.

Podcast #381: MRI… Burns?

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Author:  Sam Killian, MD

Educational Pearls:

  • 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

References:

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.

Podcast #380: Oxygen for the kill

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Author:  Ryan Circh, MD

Educational Pearls:

 

  • 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

 

References:

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

Podcast #379: Patient Perspectives of the Flu

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Author:  Sam Killian, MD

Educational Pearls:

  • Patients may have certain fears or expectations about the flu based on hearsay and other less reliable sources
  • Taking extra time explaining the risks of the flu may help base these expectations more in reality
  • This includes providing good return precautions and acknowledging that the disease can still be unpredictable

 

Podcast #378: Is That a Brown Recluse Spider Bite?

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Author:  Michael Hunt, MD

Educational Pearls:

  • 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)

 

References:

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!

Podcast #377: Endocarditis

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Author:  Nick Tsipis, MD

Educational Pearls:

  • 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

 

References:

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

Podcast #376: Alcohol Intoxication

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Educational Pearls:

  • 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

References:

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.

Podcast #375: Retrograde Urethrogram

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Author:  Jared Scott, MD

Educational Pearls:

  • 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

 

References:

Avery, L. (2012). Imaging of male pelvic trauma. Radiologic Clinics of North America., 50(6), 1201-1217.

Podcast #374: Iliac Artery Endofibrosis

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Author:  Sue Chilton, MD

Educational Pearls:

  • An unusual cause of leg pain that can mimic sciatica/claudication
  • Predominantly occurring in high endurance athletes, particularly cyclists and runners
  • More common in men
  • Check supine ABIs 1 minute after activity in the ED: a value < 0.5 is 80% sensitive

 

References:

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.