practice updates

Missed occult fractures and dislocations, in general, may result in significant morbidity for the patient and law suites for you. Six cases are presented in this episode, ranging from common scaphoid fractures to rarer dislocations. Dr. Sayal & Dr. Mamen answer questions such as: Which fractures can mimic ankle sprains and how do you avoid missing them? What are the most reliable signs of scaphoid fracture? In which occult orthopaedic injuries should we anticipate limb threatening ischemia? Which is better to diagnose occult fractures – MRI or CT? Which calcaneus fractures require surgery and which ones can be managed conservatively? and many more……

Pearls and pitfalls in managing the trauma patient and finding occult pathology: a little knowledge goes a long way

The first post in the new EM Primer Series…What are the pearls you need to know for myxedema?

Endophthalmitis is a rare, but clinically significant infection. It is often misdiagnosed due to the multitude of other ocular diseases that share similar presenting symptoms. It results from an infectious or non-infectious inflammatory process of the vitreous and aqueous humors. Missed or late diagnoses can have severe consequences, including permanent vision loss. The natural history of the disease thus necessitates a high degree of clinical suspicion in all patients, especially those at increased risk.

Sepsis is a common, serious medical condition diagnosed and managed in the ED. What do EM providers miss, and how can we improve?

Hemolytic uremic syndrome is a potentially deadly disease, comprised of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (AKI). This post evaluates the pathophysiology, evaluation, and management of HUS.

Critical pearls and pitfalls for the management of the sick dialysis/ESRD patient in the Emergency Department

Happy Holidays from all of us at emDOCs.net! Thank you to all of the amazing EM docs that have contributed to our new EM Mindset series this past year. As we take a break from this series to accumulate more of your pearls, wisdom and life lessons through your journey in EM for our next chapter in this series, we at emDOCs leave you with this EM Mindset. Enjoy!

In 2002, a new standard of care was established when the Surviving Sepsis Campaign (SSC) highlighted the importance of recognizing sepsis and initiating treatment early. Once we find that a patient meets Systemic Inflammatory Response Syndrome (SIRS) criteria with a source of infection, rapid and appropriate treatment including resuscitation is a must. Early fluid resuscitation is necessary for septic patients, but there is large variance on the aggressiveness of fluid resuscitation. There is disagreement amongst the experts on the total amount of fluids that should be administered and the end points for resuscitation. We must ask ourselves, at what point does our aggressive resuscitation actually start to harm our patients?