It’s a typical busy afternoon ED shift for you. The rack seems to be overflowing, and 3 new patients have just checked in. All have abdominal pain. You have a systematic approach to your abdominal pain patients. But, does your approach keep one critical diagnosis in mind? [...]
[Editor's note: For a limited time, Tintinalli's is making their full chapter entitled "Chest Pain: Cardiac or Not?" available to emDocs readers.]
Low-risk chest pain. Examining and challenging "standard of care."
Our AMA with Dr. Mike Mallin & Dr. Matt Dawson from the Ultrasound Podcast, held on Friday, November 14th from 2-3:30pm EST.
These children are often a mixed picture of viral bronchitis/bronchiolitis PLUS an asthma exacerbation. Treatment with albuterol, ipratropium, magnesium sulfate, steroids, fluids, etc are all reasonable and prudent in this population. If they begin to clinically improve within 30 minutes then you can feel good about soothing their reactive airways. However, they still have underlying viral issues which may require non-invasive positive pressure ventilation (either high-flow nasal cannula or BIPAP). If they do not improve within 30 minutes then you should begin to plan for IMC/ICU admission as these patients will require significant monitoring and respiratory support.
Trying to predict the future is a task that is riddled with risk. There is a very high potential that I will be wrong and my thoughts will end up being complete baloney. I'm okay with this. According to Strengths Finder 2.0, I'm futuristic, meaning that I'm inspired by the future and what could be, and hopefully will inspire you. With this in mind, two quotes that I believe should frame our conversation: "The future is already here, it's just not very evenly distributed." -William Gibson "We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10." -Bill Gates With these in mind, here are some trends that I see emerging. [...]
Leg pain...anticoagulation...Hb drop... A rare but dangerous diagnosis you do not want to miss
Aortic dissection is a life-threatening yet infrequent diagnosis, estimated at about three cases in every 100,000 person years (1,2). Because of its low frequency and emergency nature, large randomized controlled trials are difficult to conduct (3). Thus, the International Registry of Acute Aortic Dissection (IRAD) was established in 1996 to obtain up-to-date data on patients with acute aortic dissection. Currently, 30 large referral centers in 11 countries participate. Most novel research on aortic dissection is based on IRAD data. [...]
Editor's note: This article was listed in EM Curious' #FOAMed Review 19th Ed.
Quicker diagnosis (vs waiting for CT), quicker treatment (IVF, NG tube, surgery), and earlier consult/admission to Surgical team. Everyone benefits: ED flow, overburdened nurses, other patients requiring attention in the ED, and most of all, the patient himself.
