Mastering Minor Care: Bartholin Gland Abscess
/Dr. Gabor reviews normal anatomy and pathology of the Bartholin gland, and discusses multiple treatment strategies to manage this condition.
Read Moreemergency medicine tamed
Taming the SRU. The SRU is the "Shock Resuscitation Unit." It is a crucible of clinical training for the residents of the University of Cincinnati Emergency Medicine Residency training program.
Dr. Gabor reviews normal anatomy and pathology of the Bartholin gland, and discusses multiple treatment strategies to manage this condition.
Read MoreThis week’s grand rounds started with excitement with an operations update and a scavenger hunt in the new ED, congrats Team 7 on the win! This was followed by forward thinking didactics on a new protocol for manual vacuum aspirations in the ED,
Read MoreIn this month's Journal Club, we covered several articles that looked at the use of antibiotics in the Emergency Department. Does adding Trimethoprim-Sulfamethoxazole to Cephalexin increase the rates of clinical cure in uncomplicated cellulitis? For patients receiving Vancomycin in the ED, how many are appropriately dosed and how many receive a sufficient number of doses to hopefully limit the emergence of resistant bacteria? Are patients receiving Vancomycin and Piperacillin-Tazobactam really at increased risk of acute kidney injury?
Read MoreIn this post, we discuss necrotizing fasciitis and whether the LRINEC score is a useful decision-aid for the emergency physician when this disease is suspected.
Read MoreSkin and soft tissue (SSTI) ultrasound is a hotly debated area of utility, however the returning cellulitis is a hard indication. Join Dr. Ham and he presents a case of a worsening cellulitis despite adequate antibiotics, and a dive into the literature of SSTI US.
Read MoreThis week Dr. Lagasse gave us a great M&M covering intra-ocular foreign bodies, empyema management in the ED and septic cardiomyopathy. Dr. Iparraguirre lead small groups in EKG case studies in heart blocks, followed by Drs Nagle and LaFollette squaring off in a CPC of an undifferentiated patient with aphasia. Drs Goel and McKee wrapped up this week with a clinical soapbox on patient turnover and a case follow up of lytics in massive PE.
Read More1. Should ultrasound be used for abscess management?
2. Methods of Abscess Drainage
If you are an EM:RAP listener, this is the video I talked about in the November episode on abscess managment. It goes through the steps of a new technique for draining a cutaneous abscess. I am a huge fan of this procedure and use it on most abscesses that I would have otherwise packed. Why I like it: there is no packing to change, the incisions stay open because of the drain and the incisions themselves are much smaller than we historically use.
3. Should we irrigate abscess cavity?
4. Should abscess cavity be packed?
5. Primary Closure of Abscess
6. Do these patients need PO antibiotics?
Missed orthopedic fractures account for the largest source of malpractice claims and hand injuries account for 5-10% of ED visits.
ABCS method for Interpretation
Tuft fracture: typically due to crush injury
Mallet finger: forced flexion of extended DIP joint
Jersey finger: forced extension at flexed DIP
Skier's thumb: hyperabduction of thumb with FOOSH
Boxer's fracture: metacarpal neck fracture with volar angulation
Metacarpal neck fractures: need to know degree of angulation as it determines need for ORIF
Scaphoid fracture: most common fractured hand bone
Triquetrum fracture: can be associated with ulnar nerve injury, splint with a polar wrist splint
Scapholunate dissociation: injury to the ligament connecting the 2 bones
Perilunate Dislocation. From http://radiopaedia.org/articles/perilunate-dislocation
Lunate Dislocation. From http://radiopaedia.org/articles/lunate-dislocation
Distal radius fractures
Colle's fracture: distal radius with dorsal displacement
Smith fracture: distal radius with volar displacement
Radial styloid fx: high association with ligament injuries
Galeazzi fx: distal radius fx with dislocation of radial/ulnar joint
67 yo M with arm pain and numbness after a bug bite. Exam concerning for compartment syndrome. Goes to OR for fasciotomy. Becomes hypotensive on the floor with continued bleeding and oozing from fasciotomy site. Diagnosed with Acquired Factor VIII deficiency
Acquired factor VIII Deficiency
Treatment:
1. Things that will/could impact EM
2. Types of EM groups
3. When comparing, you should consider contracts "apples to apples", including: salary, malpractice, health, disability, life insurance, pension, bonus, tuition break, CME
4. Pay models: billings, RVU, salary, hourly, combo
7 week old baby presents with vomiting. Arrives at OSH and stops breathing. Gets intubated and is transferred to you. On exam, he has a missing R radius but otherwise warm and well perfused. Glucose is 53, so receives D25.
T 33.7, P 153, BP 87/54.
Labs show a pH 7.1 with base deficit 14. lactate is 9.5. WBC 16 with 68% neutrophils and 4% bands. UA negative.
CXR initialy unremarkable. EKG with R axis deviation.
The baby then becomes hypotensive with worsening tachycardia and hypoxia. Minimally responsive to fluids, though hypoxia worsens. Repeat CXR shows diffuse pulmonary edema.
Differential diagnosis: sepsis, sepsis, sepsis, metabolic disorder, congenital heart disease, nonaccidental trauma
Diagnosis: Total Anomalous Pulmonary Venous Return
Tips for sick baby:
10 day old with poor feeding and increased sleepiness. Grunting with periodic breathing on exam. HR 180s-200s, O2 sat in low 90s.
DDx: sepsis, metabolic, congenital heart disease, NAT
SRU (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.