Who’s next? (Wikimedia Commons)
Jessica Mason MD and Wendy Chan MD discuss the history and present methods of triage in the May EM:RAP podcast of Annals of Emergency Medicine: Emergency Severity Index.
How do you risk stratify in your emergency department? Do you use a three-step system of emergent, urgent or non-urgent? Or the five-step triage protocol with ESI 1 indicating a critical patient to an ESI 5 indicating nothing serious? Neither provide an ideal system, but what about front-end physician triage, split flow and vertical flow? Update your triage knowledge by listening to the podcast…it might make your day flow smoother.
Larreys Flying Ambulance (National Library of Medicine)
Who Knew? Baron Dominique Jean Larrey is credited with inventing triage during the Napoleonic Wars but did you know he invented the first ambulance? The horse-drawn “flying ambulances” could maneuver quickly across a battlefield delivering injured men to field hospitals.
Giraffe (WikiCommons photo)
Blunt neck trauma can be an airway nightmare. Listen to the podcast or catch the bullet points about workup and treatment from the May 2018 EMRAP article by Mel Herbert MD and Billy Mallon MD called Blunt Neck Trauma.
Who Knew? A giraffe’s neck is too short to reach the ground. It spreads its front legs or kneels to reach the ground for a drink of water.
Early ECG machine. Photo from Wikipedia.
According to Medscape, an online medical information site: “a heart rate of more than 160 beats per minute in infants and a respiratory rate of more than 60 per minute are associated with an increased mortality risk and often signal the development of septic shock.”
The May EM:RAP Pediatric Pearls podcast by Dr. Ilene Claudius, Dr. Sol Behar, Dr. James Salway and Dr. Liza Kearl offers prudent advice on differentiating respiratory from cardiac sources of pediatric tachycardia. Or pull up the PDF and have a fast read of the bullet points to keep your rate in check and your knowledge bounding.
Who Knew? Willem Einthoven, working in Leiden, the Netherlands, used the string galvanometer (the first practical electrocardiograph) he invented in 1901 which was more sensitive than previous 1870s inventions. He assigned the letters P, Q, R, S, and T to the waveform deflections. (Wikipedia)
WikiMedia Commons photograph.
If you look at the statistics in the USA most myocardial infarction patients survive with a 3-6% mortality rate, but the ST-Segment Elevation Myocardial Infarction (STEMI) and cardiogenic shock patients have an uphill battle no matter where they present. Dr. Greg Adaka offers 5 bullet points, less than a minute to read, on the February EMRAP pdf called: Cardiogenic Shock in Acute MI. Thumb drives up…take less than a minute to refresh your hearty knowledge base.
Who Knew: Myocardial Infarction, according to the WHO, is second only to lower respiratory infections as the leading cause of death in lower income countries. Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year. Courtesy: Wikipedia.
“Stayin’ Alive” is a disco song written and performed by the Bee Gees in 1977…anyone still have their mirror ball?
(Photo courtesy WikiCommons)
Fertilized egg of Ascaris lumbricoides. (Photo courtesy of WikiCommons)
Ascariasis is a common helminthic infection, with an estimated worldwide prevalence of 0.8-1.22 billion people. But it’s rare in the USA because it’s not endemic. Most often seen in travelers I’m inclined to think I missed cases during my years of practice.
Update your knowledge and listen to the EMRAP November podcast or hit the high points in the PDF file. Annals of Emergency Medicine: Ascariasis by Jessica Mason MD, Andy Grock MD and Andrea Tenner MD
I’d like to hear from our Nepal colleagues’ pearls on recognition and the complications. Leave a comment. How often have you seen asymptomatic versus symptomatic cases? What’s the worst complication you’ve managed?
Who knew? “During our relatively short history on Earth, humans have acquired an amazing number of parasites, about 300 species of helminth worms and over 70 species of protozoa. Many of these are rare and accidental parasites, but we still harbor about 90 relatively common species.” Clin Microbiol Rev. 2002 Oct; 15(4): 595–612.
What does a cotton swab and nose have in common? (photos from WikiCommons)
In August I posted on the common presenting complaint: migraine headaches…but there’s more.
Dr. Michelle Lin talks about anti-dopaminergic agents, triptans, IV fluids, routes of administration and steroid use. And who thought a cotton swab was your instrument of choice when treating a migraine headache? I didn’t. Check out the Lin Session: Migraine podcast from the EM:RAP November edition to add more skills to your headache arsenal.
Then add a chaser with Paper Chase #4 from the same edition which talks about parenteral acetaminophen (paracetamol). You’ll be surprised by the mechanism of action.
Who knew? The cotton swab is a tool invented in the 1920s by Leo Gerstenzang after he watched his wife attach wads of cotton to toothpicks. His product, which he named “Baby Gays“, went on to become the most widely sold brand name, “Q-tips”, with the Q standing for “quality”. (Wikipedia)
With a jolt of information on button battery ingestions by pediatrician Ilene Claudius. The November 2017 EM:RAP edition has a podcast sure to shock you. From one end of the tail to the other, your patient outcomes can range from benign ingestion and passage over a few days to death.
A variety of button batteries found in toys. (Photo from Wikimedia Commons.)
The leakage of alkaline materials will cause liquefaction necrosis rapidly. (Photo from Wikimedia Commons.)
Button battery or coin? Read the EMRAP PDF or listen to the podcast to learn how to differentiate. (Photo from http://www.radiologypics.com)
The National Capital Poison Center posted the NBIH Button Battery Ingestion Triage and Treatment Guideline: https://www.poison.org/battery/guideline
Battery ingestions are no laughing matter but I can’t end without one bad joke: What did the depleted battery say to the judge? “Feel free to charge me.”
“Doctor, I am dizzy.”
Dizziness is a common presenting patient complaint. When is it serious and when is it benign. For back pocket HINTS on how to differentiate Posterior Circulation Strokes from weak and dizzy listen to this September podcast. It’s available using your CMES thumbdrives or CMES-Pi.
Posterior Circulation Stroke vs. No Big Deal (THE HINTS EXAM) Anand Swaminathan MD and Evie Marcolini MD