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A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. Hemoptysis ED approach and management. Its going to take time to get her to a tertiary center.
Takeaway lessons * Trauma patients who are hypotensive or otherwise unstable should be assumed to be bleeding, bleeding, bleeding until proven otherwise, and should have a very low threshold to proceed directly to the operatingroom for exploration.* pneumatically), then definitively addressed by Orthopedics at their convenience.
In her spare time, Melissa also enjoys being the fellowship director to an amazing group of PEM trainees. Case: Brian is a 14-year-old male who presents to the emergency department (ED) complaining of acute onset testicular pain. He has vomited twice, but there is no history of any fever or trauma. Reference: Frohlich LC, et al.
A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. F, RR 16, SpO2 97% on room air. Vital signs include BP 90/48, HR 122, T 98.3
The standard care in North America for post-traumatic EDH involves decompressive craniotomy or trepanation via a burr hole, typically performed in an operatingroom by neurosurgery teams. Initially refusing emergency medical services, she was brought to the ED via a private vehicle. What are the key takeaways? (1)
This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. The impact of push-dose phenylephrine use on subsequent preload expansion in the ED setting. 2015;10(3):e0119331. PMID: 25789927 Schwartz MB, et al. Am J Emerg Med.
A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. On hospital day 2, he was taken to the operatingroom for surgical rib fixation. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.)
Background Information: Obtaining definitive control of the airway, when indicated, is the responsibility of the emergency medicine physician. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care.
A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operatingroom videos, recovery tips, and patients praising their plastic surgeon. 9 PFE is only definitively diagnosed on autopsy and a high clinical suspicion must be maintained in high-risk patients.
1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. 4 Pain is the most common reason for presentation in the early post operative period. 10% of patients.
C, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. Figure 1: The Young-Burgess classification of pelvic ring fractures (source: [link] 3 It is paramount to differentiate the definitions of “hemodynamically unstable” and “mechanically unstable” pelvic fractures.
Evaluation Imaging A definitive diagnosis of LBO requires imaging, most often a computed tomography (CT) scan with intravenous (IV) contrast. and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential.
of hospitals reported that they had to transfer patients, leading to delays in definitive care. Time is testicle , reminding us that the sooner we get a definitive diagnosis and treatment, the more likely we are to save future generations. Clinical predictors for testicular torsion as seen in the pediatric ED. Beni-Israel, T.,
3 The majority of those who arrive to the emergency department (ED) live for 2 hours or more, leaving a small window for surgical intervention. CT is more definitive but can take more time. Other exceptions are patient refusal, patient death or immediate transfer to the operatingroom. Br J Surg 2012;99:655-665.
6,13,17 Challenges in Diagnosis: The diagnosis of Fournier’s gangrene is clinical: There are no laboratory or imaging studies that can be used to definitively rule out disease. 20,21 Imaging may be helpful in diagnosis or surgical planning but cannot rule out NSTI and may delay definitive surgical management.
Temporomandibular (TMJ) Joint Dislocation Definition: Displacement of the mandibular condyle from the temporomandibular fossa. Rosens Emergency Medicine: Concepts and Clinical Practice, 7 ed. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Louis, Mosby, Inc., 2010, (Ch) 70: p 895-909. GorchynskiJ et al. Mendez DR et al.
While this guide isnt exhaustive, its designed by residents, for residents, to provide practical tips and foundational knowledge thats crucial in the fast-paced, high-stakes environment of the ED. Introduction Airway management is a critical ED skill to master. So the actual benefit for most ED patients is unclear.
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