Hyperbilirubinemia: Mellow Yellow Isn’t Just a 1960’s Song

Phototherapy for neonatal jaundice. (photo courtesy Wikicommons)

Hyperbilirubinemia: one of the most common problems seen in term newborns and warrants a periodic review to refresh our knowledge base. Consider this case: A well-appearing infant presents and is jaundiced. The baby has a cephalohematoma and is breast feeding. Everything else is fine. The child is eating well and urinating. Do you still need to send labs?

Take a listen to the MP3 podcast or read the PDF in the January EMRAP podcast: Hyperbilirubinemia by Rob Orman MD and Tim Horeczko MD.


Who Knew? Jaundice was observed for centuries but the earliest medical literature was by Jean Baptiste Thimotee Baumes (Baumes, J. 1806). This description was published as a chapter in a book entitled: Traite de L’amaigrissemwnt des enfans. Christian Schmorl in Dresden was the first to coin the term “Kernicterus” in 1904.



Pneumonia Reboot: Admit or Discharge Decisions

CXR of a 37-yr-old male with pneumonia and abscess. (Photo from Wikicommons).

CT scan of the chest showing bilateral pneumonia with abscesses, effusions, and caverns. 37 year old male. (Photo from Wikicommons)

The case as presented in the January 2018 EMRAP files:

A 73-year-old male with a history of hypertension, hyperlipidemia and aortic stenosis presented with cough, fever and sputum. He was mildly tachycardic but not tachypneic and was well-appearing. On lung exam, he had some focal wheezes in the left lower lobe. Swaminathan thought the patient had pneumonia. Chest x-ray confirmed a left lower lobe infiltrate.

Now what? What else do you need to know about this patient that impacts discharge planning. It’s flu season here in the USA, the ED and wards are filled with critical patients and beds are in high demand. Do you really need to admit this patient? Tie up a bed? Expose him to hospital-acquired infections?

Listen to the January EMRAP Introduction podcast or read the PDF by Rob Orman MD and Anand Swaminathan MD to find guidance and opinions.

Who knew? The CURB-65 and the PORT Score can help you make these difficult decisions.

Osteomyelitis: The Diabetic’s Skeleton in the Closet

Femur. Osteomyelitis. From ancient cemetery, Chicama Valley, Peru ; (Photo courtesy WikiCommons)

X-ray osteomyelitis 1st metatarsal joint (photo courtesy WikiCommons)

Do you admit all your diabetic patients with suspected osteomyelitis? Do you need to?

Is it acute or chronic?

Do you need to culture all diabetic foot ulcers?

What two entities will help identify patients at risk for osteomyelitis? The answer may surprise you.

Download from CMES the podcast or PDF for the December EM:RAP Diabetic Foot Ulcers by Matthew DeLaney MD and Charles Khoury MD and share your experiences or recommendations by leaving a comment.


Who Knew? Evidence for osteomyelitis found in fossil records are studied by paleopathologists, specialists in ancient disease and injury. It has been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis.

Life Threatening Bleeds in Oral Anticoagulated Patients

Noval Oral Anticoagulant (NOAC) medications. Travelers like the convenience because they don’t need monthly blood tests. It also means they show up in your emergency departments and clinics from all over the world with minor and major bleeds. How do you know what reversal agent to give or even if there is one? Perhaps they can’t recall the name or a friend is watching their belongings at the hotel.

Check out the December Annuals of Emergency Medicine podcast: Reversal of NOACs by Jessica Mason MD, Andy Grock MD and Annahieta Kalantari DO. The simple answer may surprise you.

Who knew? Hirudin extracts from the medicinal leeches were first used for parenteral anticoagulation in the clinic in 1909, but their use was limited due to adverse effects and difficulties in achieving highly purified extracts. Published by NCBI PubMed 2012 Jun 1;9(2):83-104.