Tamingthesru
Closing the Gap: Deep Sutures
While many wounds are adequately repaired with simple interrupted sutures, not infrequently we are confronted with wounds that require more specialized suturing methods. One such method is deep sutures. Here to answer some questions regarding deep sutures is our wound management guru, and author of the book “Wounds and Lacerations: Emergency Care and Closures,” Dr. Alexander Trott.
Annals of B-Pod: Acute Vision Loss
Thinking about the other left lower quadrant
The patient is a 74 year-old African-American female with a history of hypertension, coronary artery disease status post drug-eluting stent ×1, former cigarette smoker, and iron deficiency anemia presenting with left-sided vision loss. Patient states that approximately two days ago she woke up with painless peripheral vision loss of her left eye only. She describes it as darkness in the lateral portion of her left eye. She reports that her vision returned to baseline throughout that day; only to return when she awoke the next morning. Since that time she endorses persistent vision loss in the left periphery. She denies blurry vision, eye pain, headaches, recent trauma, flashes, and floaters. Furthermore, she also denies dizziness, numbness weakness, dysarthria, dysphagia, fever, chills nausea, vomiting, chest pain, shortness of breath, and palpitations. She reports adherence to her antihypertensive and anti-platelet medications...
Annals of B-Pod: Approach to the Febrile Infant
Imagine it’s your first moonlighting shift at a small rural community hospital. The nearest referral center for both adults and children is 90-minutes away by ground. The annual census of the emergency department is 15,000 patients per year, of which only 5% is pediatric. There are 2 hours left in your 12-hour shift and your energy is all but spent. You are looking forward to winding down at home after an extremely busy and high-acuity shift when your 35th patient of the day checks in. The patient’s chief complaint is fever. You give yourself an internal fist pump thinking that you’re about to see your 12th viral URI of the day and that you’ll be in-and-out of that room no in time. In the midst of your premature celebration you scan the nursing note and see the age of the patient: 6 weeks…You’re hopes of a quick and easy disposition suddenly melt away leaving you with many more questions regarding this patient’s care than answers…You muster your remaining energy and make your way toward the patient’s room.