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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?

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    Articles

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    EM@3AM: Alpha-2 Agonist Toxidromes

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    A 42-year-old male with a past medical history of substance use presents to the ED for chest pain, shortness of breath, nausea, and vomiting. He reported snorting fentanyl two days ago and has a remote history of IV drug use. Vital signs include 98.8°F, HR 150, RR 23, SpO2 98%
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    • electrocardiography

    ECG Pointers: CALS versus ACLS

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    What is Cardiac Advanced Life Support, and what does it entail?
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    • In the Literature, practice updates

    Policy Statement: NSTI Survival Guide

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    The Global Alliance for Infections in Surgery published a position statement comprised of recommendations for evaluation and management of necrotizing soft tissue infections. We summarize the key takeaways.
    NSTI Featured
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    emDOCs Podcast – Episode 136: Ectopic Pregnancy Myths Part 2

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    We're back with myths and misconceptions in ectopic pregnancy testing, focusing on urine and serum β-hCG and ultrasound.
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    • In the Literature

    Journal Feed Weekly Wrap-Up

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    Journal Feed covers resuscitation before intubation, insulin for hyperkalemia, and the PENG block.
    Journal Feed
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    POCUS Diagnosis of NSTI

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    How can you use POCUS to evaluate for necrotizing soft tissue infection?
    Feature POCUS NSTI
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    Spinal Epidural Abscess

    Risk factors: recurrent vascular access, immunocompromise, spinal instrumentation; don’t forget diabetes and ESRD

    Triad (fever + back pain + neuro deficit) not reliable

     

    Evaluation: incorporate risk factors and exam (fever, neurologic deficit)

     

    Imaging: MRI whole spine with and without contrast; 15% have skip lesions

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