EM-Neuro Combined Lecture WITH Dr. NeEl
Is the problem neurologic?
If neurologic, what is the location?
Focal, Multi-focal, or Diffuse?
Atrophy and pain point more toward peripheral etiologies
What is the timing of the problem?
Acute: seconds to minutes
Subacute: hours to days
Chronic: >6 weeks
Progressive or non-progressive?
What are likely etiologies?
Case 1: A middle-age woman presents with acute numbness in the entire left arm with 8/10 headaches. Her symptoms were present for three hours but have now resolved.
Acute and focal
Etiologies include vascular (stroke and TIA), seizure, migraines
Seizure risk factors:
Past trauma to head with concussion or skull fracture
History of seizure as child
Family history of seizures
History of meningitis or encephalitis
Case 2: A 35 year old female presents with a breakthrough seizure. She is back to baseline. She is on lamotrigine 200mg BID and Keppra 1000 BID.
Think about pregnancy, infection, and medication noncompliance
Have a low threshold to call the patient’s epileptologist to help co-manage patients, especially in adjusting medications
Case 3: A 32 year old male presents with 1-2 weeks headaches and intermittent confusion over the past two days. He is unable to give a coherent history.
If concerned for meningoencephalitis: start vancomycin, ceftriaxone, acyclovir, and ampicillin
Differential diagnosis includes infectious, metabolic, autoimmune, iatrogenic, toxicologic
Case 4: A middle age male presents with 10/10 low back pain shooting down the legs while working at a construction site. He feels weaker than normal.
What are low back symptoms?
Pain: arthritic pain, claudication (can be neurogenic or vascular), radicular pain
About 50% of patients with Guillain Barre syndrome present with pain.
Blunt Pancreatic Injury WITH Dr. Jarrell
Approximately 0.2-12% of patients with abdominal trauma will have pancreatic injury
Diagnostic imaging modality of choice is CT scan
Imaging findings of pancreatic injury are often delayed, potentially up to 12 hours
EAST Guidelines on Pancreatic Injury Grade
Grade I/II: Hematoma or laceration to body of pancreas not involving the duct
Likely non-operative management
Grade III: Duct injuries in the body and tail of the pancreas
Grade IV: duct injury in the head of the pancreas
Grade V: transection of the pancreas
Octreotide is not recommended, as this has been shown to increase mortality
Characteristics to be cautious of:
Presenting to multiple different hospitals
Stories that don’t match up
Approximately 17% of patients with abdominal injury from non-accidental trauma will have a pancreatic or hollow viscus injury
Two-thirds of pancreatic injuries in pediatrics are from non-accidental trauma
Global Health Grand Rounds WITH Dr. Wyrick
In 4 days, was able to operate on 31 patients
12 distal femur osteotomies
12 high tibial osteotomies
4 Achilles tendon lengthening
3 hand burn contracture releases
Tibial malunion osteotomy
Saw a total of 125 clinic patients
Lower limb deformities are common and likely related to nutritional disorders, as many of them are bilateral
R3 Small Groups: Ortho Injuries WITH Drs. Iparraguirre, Jensen, and Lane
Most fractures are mid-shaft
Indications for emergent referral:
Tenting of skin
Indications for urgent referral
Greater than 1 bone width of displacement
Cosmetic or functional recovery
Treat with sling and pain control
Foot and Ankle
Can use pencil as a fulcrum to attempt reduction of toe fracture-dislocation
Ankle nerve blocks
Perform a ring block around the most superior portions of the malleolus
This will provide most of your anesthesia by blocking the superficial peroneal, sural, and saphenous nerves
No consistent injury patterns
Look for fleck sign and diastasis
Can obtain weight-bearing views or CT if high clinical suspicion
Distal Radius Fractures
Hematoma block with hanging has similar outcomes (potential even better reduction) than sedation with manual reduction