The Case: 38 year-old-male no PMH presents with severe RUQ pain for 1 day with nausea and nonbloody/nonbilious vomiting but no diarrhea. No history of abdominal surgeries. BP 155/103 HR 61 RR 18 Sp02 100% on room air temp 97F. On physical exam patient was pale, diaphoretic, and in severe distress. His abdomen Read more…
By: Yonatan Yohannes, MD Abdominal Compartment Syndrome Who: The critically ill. Most commonly in shock, burn patients, polytrauma patients. What: Primary -> abdominopelvic disease/injury: trauma, pancreatitis, surgery, etc. Secondary -> conditions originating elsewhere: sepsis, burns When: Normal IAP (intra-abdominal pressure) 5-7mmHg IAH (intra-abdominal hypertension) IAP ≥ 12mmHg ACS Read more…
A 19 year-old patient presents to your ED with a nosebleed. His friend states they were in the bleacher seats of an anime convention when he became so aroused that his nose just started gushing blood. He’s been bleeding for about 30 minutes despite holding pressure on his nose. Vitals are normal. When Read more…
Sepsis is no longer defined as SIRS + a suspected source but rather “life-threatening organ dysfunction due to a dysregulated host response to infection”. This is according to the new guidelines released by the Sepsis-3 task force in 2016. By creating this new definition, they shift the focus of sepsis Read more…
It’s the afternoon and three level 1 trauma codes have come and gone. You are sitting in front of your computer schmoozing with your senior who is clearly not listening to you. She is obviously thinking about that job that she got on that other “better coast” with sunshine, organic starfruit and “proper Mexican food”. Mid-sentence you suddenly notice that you Read more…
By Jaime Moran MD, PGY-3 Edited by Dr. deSouza Acromioclavicular joint dislocations: the “Separated” shoulder EPIDEMIOLOGY & MECHANISM OF INJURY 9-12% of shoulder girdle injuries More common in males Usually results as a direct blow to the shoulder; less commonly fall onto an outstretched arm. Most commonly falling onto the Read more…
The anion gap is a calculated measure. It is used to help determine metabolic causes of acidosis and can suggest underlying pathology in an undifferentiated patient. The full formula for calculating an anion gap is: ([Na+] + [K+]) − ([Cl-] + [HCO3−]) = 16 mEq/L This is frequently shortened to: Read more…
Mechanism or Injury — Anterior TMJ dislocation are the most common type of jaw dislocation. They typically occur due to opening the mouth in an extreme manner such as yawning. Others causes include trauma, dystonic reactions, seizures, or tetanus infection. Iatrogenic dislocations may occur during anesthesia induction and upper endoscopy. Symmetric mandibular Read more…
Chest pain: Cause for more than 8k…no, 80k…no, 8 MILLION visits!! What this is about? -Not the 60 year-old sweaty guy with crushing chest pain, ST-Elevations, and trop of 4000 (How many of those do you see?) -Not the 18 year-old girl elbowed in the chest, now with a bruise, Read more…
Presented by: Dr. Eris Cani / Summarized by: Dr. Sarah Jung / Reviewed by: Dr. Stanley Moy HAPPY 2016!!! Summary: Procalcitonin is a specific biomarker that can be useful for diagnosing bacterial infections Most evidence for PCT utilization is for patients with LRTI (rule-in or rule-out pneumonia) Read more…