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EM@3AM: Cortical Hand-Knob Stroke Mimicking Peripheral Nerve Injury

A 95-year-old man presents after waking with sudden inability to move the fingers and thumb of his right hand. He can lift his arm, flex and extend his wrist normally, and reports intact sensation. He denies numbness, facial droop, dysarthria, headache, gait disturbance, chest pain, or dyspnea. He has 0/5 strength in finger flexion and extension as well as in the intrinsic hand musculature, with preserved proximal upper extremity strength and intact sensation. He has no other appreciable deficits and normal vital signs. What is the diagnosis?

Articles

"Rule out SBO"

June 6, 2014
Adaira Landry
2 Comments

A diagnostic dilemma from the case files of Janus General. The presentation of this clinical zebra is provided by one of our esteemed editors, Adaira Landry, MD (@AllAroundDoc).

Massive Vaginal Bleeding

June 5, 2014
Jessica Hetherington Lopez
No Comments

"Packing may be the most effective hemostatic temporizing measure that can be performed in the ED"

Jessica Lopez, MD discusses the management of the non-pregnant patient with severe vaginal bleeding, including tamponade techniques and the utility of tranexamic acid.

Shoulder Ultrasound: Intra-Articular Injection and Reduction

June 5, 2014
Tyler Dschaak
One Comment

"One systematic review found intra-articular injections to be as safe and effective as procedural sedation for bedside shoulder reductions"

Last month Tyler Dschaak, MD told us about using ultrasound to diagnose a septic hip. Today's post is on the utility of ultrasound in the diagnosis and management of shoulder dislocations.

Options to Intravenous Fluids

June 5, 2014
Sean M. Fox
No Comments

IO Placement: "Should be done without hesitation in a child who lacks easily obtainable IV access and signs of poor perfusion"

Placing an IV in a sick pediatric patient can be a real challenge. Fortunately, there are options! Thanks to Sean M. Fox, MD (@PedEMMorsels) for this gem with significant clinical

IV Contrast Myths

May 28, 2014
Anand Swaminathan
7 Comments

"Premedication with corticosteroids has never been shown to reduce the risk of moderate or severe adverse drug reactions"

We're thrilled to present another game-changing writeup from Anand Swaminathan, MD MPH (@EMSwami), this time on the conundrums of shellfish allergies and utility of premedication in patients receiving IV contrast.

Electronic Cigarettes and Liquid Nicotine Poisoning

May 20, 2014
Jhonny Ordonez
2 Comments

"The delayed phase consists of cns and respiratory depression, dyspnea, bradycardia, hypotension, shock, mydriasis, weakness, muscle paralysis, and coma"

We are very pleased to present you with this overview on the potential dangers of electronic cigarettes and liquid nicotine from the toxicologists at UT Southwestern.

High lateral OMI

Elevation in I, aVL, +/- V2 with depression in inferior leads, especially III (South African Flag sign); occlusion of first diagonal branch or left circumflex artery