Dorothy’s original ruby slippers (Wikicommons)
Neonatal stools are a source of concern for parents and color changes can trigger a visit to the emergency department or outpatient clinic. What colors raise your index of concern for serious pathologies such as necrotizing enterocolitis, malrotation with midgut volvulus or intussusception? Plug in your thumb drive or roll out your CMES app and take a listen to Jess Mason MD and Jason Woods MD as they discuss the EM:RAP podcast called Neonatal Stool Rainbow. You won’t find the Wizard of Oz but you’ll take home some knowledge…even without your ruby slippers.
Glucometer. Courtesy Wikicommons.
Once a month I will comment on the Rural Medicine podcast from EM:RAP. It’s exciting to read CME that can be applied globally no matter where you live or what resources you have at hand. Diabetic Ketoacidosis (DKA) In The Village by Vanessa Cardy MD and Stuart Swadron MD can be found in the February 2019 EM:RAP podcasts or take a quick read of the PDF for bullet points.
The question of the month? How do you manage DKA when you don’t have access to labs?
Urine dip strip. Courtesy Wikicommons.
And…is the urine ketone strip a good test?
Pediatric patients at mobile clinic, Tena, Ecuador.
Each month EM:RAP offers a podcast called Pediatric Pearls. Take a listen or read the January edition titled: Pediatric Gynecology Complaints by Ilene Claudius MD and Emily Willner MD. Neonates with blood in the diaper, difficult catheterizations, and how are vaginal exams different in children are a few of the useful topics covered.
Share your experiences and advice. How does your facility manage pediatric emergencies?
Airway Management is just that…managing the airway upside down and inside out. Take a quick read of the PDF or listen to EM:RAP’s November MP3 audio podcast called Strayerisms: Fluid Filled Airway. It’ll float your boat.
Correct ET tube placement, but if you tube the esophagus, leave the ET tube in place and use it as a landmark.
According to Dr. Reuben Strayer MD, the author, there are four ways to harm your patient during airway management: failure to oxygenate; failure to ventilate; worsening perfusion; and aspiration. His suggestions are doable no matter where you practice or what resources you lack…remember…your greatest resource is knowledge.
Who Knew? Probably the oldest recovered boat in the world, the Pesse canoe, found in the Netherlands, is a dugout made from the hollowed tree trunk of a Pinus sylvestris that was constructed somewhere between 8200 and 7600 BC. This canoe is exhibited in the Drents Museum in Assen, Netherlands. (Not looking too seaworthy these days.)
Steroid molecule. (Wikimedia Commons)
In Hamlet Act 3, scene 1, Shakespeare wrote; “To be, or not to be: that is the question”. Hamlets most famous soliloquy is both memorable and intriguing because he was contemplating profound ideas. Something you do every day, every shift and every hour while working…you contemplate decisions based on best practice, cutting-edge articles, and new research. One such question has haunted us for decades…to give or not to give steroids to septic patients.
Take a listen or read the August EMRAP article titled: Critical Care Mailbag: Steroids for Septic Patients by Anand Swaminathan MD and Scott Weingart MD for a fresh perspective.
On Jan 19th, 2018 the ADRENAL Trial results were published trying once and for all to answer the question of adjunctive steroids in septic shock. Take a look at this condensed version.
Rheumatoid arthritis (Wikimedia)
Who Knew? In 1948 the first patient with rheumatoid arthritis was treated with cortisone. Between 1954 and 1958 six synthetic steroids were introduced for systemic anti-inflammatory therapy. By 1960 all of the toxic effects of chronic corticosteroid administration had been appreciated. In the 1970s the introduction of methotrexate helped restrict the dosages and indications for corticosteroids in the rheumatic diseases.
What do Chubby Checker and testicular torsion have in common? (Wikimedia photo)
The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and mild tenderness to palpation in the right lower quadrant without rebound. His abdominal ultrasound was inconclusive; the white blood cell count mildly elevated, and the urine microscopy normal. He was admitted for observation. Twelve hours later the patient developed a fever and severe groin pain. A genital exam revealed classic findings for testicular torsion. The testicle was not salvageable. Unfortunately, the patient was born monorchism and rendered sterile by the orchidectomy. The lesson from this case: always include a genital exam in patients with lower abdominal pain.
Can you rely on the history and physical exam to rule out testicular torsion? Is the testicle salvageable after 6 hours? Wrench yourself away from your music downloads and listen to the EM:RAP August podcast called Testicular Torsion by Rob Orman MD and Larry Mellick MD. Get an update and review on this twisted entity and you won’t spiral out of control when faced with the possibility.
Who Knew? “The Twist” is an American pop song written and originally released in 1959 by Hank Ballard and the Midnighters. It was made popular by Chubby Checker, an American rock n’ roll icon, who put his stamp on the song with the twist dance style.
So what do Chubby Checker and testicular torsion have in common? As Mr. Checker said, “Come on let’s twist again…”. Testicular torsion pain can come and go.