The headache is the simplest and most complex we see on a daily basis in the ED, but it is important to consider, on both ends, how the coagulation cascade can go awry and be a causative source. Dr. Gawron walks us through a patient presenting with an unprovoked and rather discourteous dural venous sinus thrombosis, its natural history, and appropriate emergent evaluation and management.
Read MoreSpinal cord injuries are nothing to shake your head at, though. As Dr. Jensen eloquently dissects in his review of neurogenic shock, emergency physicians can play a tremendous role in the ultimate outcomes of patients with vasodilatory shock secondary with the prompt recognition and appropriate management of spinal cord pathology.
Read MoreIt is said that that the relatively high salt content of human serum and cerebrospinal fluid stems from our ancestral ties to the sea, that we carry a bit of the ocean around inside of us as a legacy, an homage to the brave evolutionary progenitor that first crawled out of the water and onto land. Unfortunately, our bodies must work hard to maintain that hypertonicity. Small fluctuations in our serum and CSF sodium content can lead to significant swelling or, more devastatingly, pronounced shrinking. Dr. Frederick’s fabulous article deftly details the clinical entity known as osmotic demyelination syndrome. Soak up the presenting features, clinical management, and dire prognosis of this much feared but rarely seen pathology.
Read MoreThough we may not realize it, human trafficking continues to consume the lives of young women and men throughout the world, including the United States. In this excellent piece, Dr. Jarrell details a presentation of a victim of trafficking to the emergency department and discusses various historical and physical exam findings that should raise a provider’s concern for possible human trafficking.
Read MoreThere are not many universal, unequivocal truths in medicine, but we can mostly agree that breathing is pretty important. It follows that diseases, injuries, or illnesses that interfere with our airways are problematic. Hereditary angioedema is a uniquely terrifying pathology in which the body’s inflammatory system is aberrantly activated, leading to swelling and collapse of a patient’s larynx. In this case, Dr. Shaw walks us through a presentation and management of a patient with hereditary angioedema in the emergency department.
Read MoreHot off the presses, be the first to take a gander at the Annals of B-Pod summer 2018 issue! From neurosyphilis to pneumomediastinum to life-threatening baclofen withdrawal, you'll find that it's not just the summer heat making you sweat as we recount tales of these "great imitators" - clinical conditions that may present perniciously or deceive providers with their nebulous constellation of symptoms. Read about all of these and more on the latest issue of Annals of B-Pod!
Read MoreMuscle relaxants see a wide variety of uses in the emergency department. From the treatment of sprains and strains to the management of spasticity in patients with upper motor neuron disease, agents like baclofen, cyclobenzaprine, and methocarbamol are well-established elements of an emergency physician’s armamentarium. With prolonged utilization, however, patients may develop dependence on these agents. Furthermore, this dependence may progress to potentially life-threatening withdrawal symptoms should the muscle relaxants be abruptly discontinued. In this article, Dr. Gottula walks us through the presentation and management of a patient suffering from a severe baclofen withdrawal following the failure of her intrathecal pump, including a discussion of the underlying pathophysiology and diagnostic considerations in the emergency department.
Read MoreOne of the fundamental axioms of medicine, passed down from generation of physicians to generation of physicians, “it could be syphilis” Perhaps no spirochete has garnered such infamy nor acrimony as Treponema pallidum. In this impeccably researched piece, Dr. Hall delves into a presentation of neurosyphilis, a devastating manifestation of the infection stemming from transmission of the bacterium into the central nervous system. Dr. Hall details the presenting symptoms, diagnostic approach, and emergent management of syphilis before delving into the various other forms this “great imitator” might take.
Read MoreAir. It’s generally considered a pretty good idea. A fundamental aspect of aerobic metabolism and an essential need for most organisms on earth, it’s safe to say that life without air for a human isn’t much of a life at all. But what happens when air starts making mischief? What happens when air shirks the restrictive confines of the alveoli and elects instead to explore the muscle and subcutaneous tissue, seeks to admire the heart and great vessels, opts to race unencumbered along fascial planes and aponeuroses - what do you have then?
Well, a pneumomediastinum for one. In his article, Dr. Skrobut does a breathtaking job of detailing the presentation of a young patient with spontaneous pneumomediastinum, delving into the diagnostic modalities of choice, its emergent management, and the longterm prognosis. His article also seeks to clear the air about more controversial topics, including the role of empiric antibiotics and the need for surgical intervention.
Read MoreWhat's in a name? That which we call Creutzfeldt-Jakob disease by any other name would be as devastating. And how, do neurologists ever love their names! CJD - also known as "spongiform encephalopathy" and the comically grim "mad cow disease" - is an uncommon but uniformly fatal form of rapidly progressive dementia. In this case, Dr. Makinen takes us through the presenting features, definite diagnosis, and emergent management of the prion-mediated encephalopathy we call CJD. An entity which would, were it not CJD call'd, retain its dear morbidity.
Read MoreIf nothing else, the "Tide Pod challenge" has demonstrated that these versatile detergents truly excel in their intended purpose, cleaning not only dirt and sweat from your clothes but also purging the naive, vain preadolescent innocence from society. Join me - Dr. Scanlon - as I detail a fascinating case of a caustic ingestion, exploring the natural history, emergent management, and ultimate sequelae of this potentially devastating exposure.
Read MoreDIC is a much dreaded dysregulation of the body's natural coagulation infrastructure associated with very high morbidity and mortality. DIC is a diagnosis that emergency providers cannot miss, and in his case Dr. Shaw walks us through the timely identification and treatment of DIC in the emergency department while simultaneously shedding light on much of the controversy that surrounds DIC. Do blood products help correct the coagulopathy? Find out inside!
Read MorePseudoaneurysms are a potentially deadly complication of any traumatic injury to or manipulation of a patient's vascular structures, and are highly morbid when not identified and treated appropriately by medical personnel. In this fascinating case, Dr. Klaszky walks us through the presentation, diagnosis, and management of a traumatic pseudoaneurysm.
Read MoreTTP, ITP, HUS, DIC - the category of hematologic emergencies is rife both with three-letter acronyms and potentially devastating complications for those patients afflicted with them. Told from the perspective of an internist, this article by medicine chief resident Dr. Baez details a case of thrombotic thrombocytopenic purpura (TTP) through the entirety of the patient's care, beginning with its presentation in the ED and ending with patient's ultimate recovery. In this article, Dr. Baez also details the newly minted, clinically-validated PLASMIC score, a scoring system that can be used in the ED to facilitate diagnosis of TTP. Check it out!
Read MoreFor many emergency physicians, ophthalmologic complaints are seemingly shrouded in mystery and pose a distinct diagnostic and therapeutic challenge. What the heck is gonioscopy? Which eye does OU refer to again? Does latanoprost really change the color of your iris? In this case, we join Dr. Murphy-Crews as he parses the enigma of acute closure glaucoma, its pathophysiology, and the appropriate management in the emergency department.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
