UCONN Emergency Medicine Interest Group

Archive for November, 2011|Monthly archive page

Ultrasound Case #6

In RADIOLOGY on November 29, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: left leg swelling

HPI: 81 yo male with PMH HTN, DM2, h/o colon cancer with recent colon resection one month prior presents to ED with left leg swelling, beginning 2-3 days ago.  Denies any chest pain, fevers, chills, h/o recent travel or urinary complaints.

SH: history of 20 pack years but quit 10 years ago.  No other drugs.

FH: denies.

PE: afebrile, VSS
Left lower extremity: calf edema, remarkably larger than the right. No tenderness to palpation, no erythema.  Distal pulses intact.

Labs: WBC slightly elevated at 11.8, otherwise rest of CBC and Chem7 grossly wnl.

Bedside U/S: see above images.

Where are the 2 points that should be compressed to look for a lower extremity DVT? What was the finding in this case?

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Upcoming meeting (tonight)

In ANNOUNCEMENTS on November 28, 2011 at 1:11 PM

The next EMIG meeting has been scheduled for Monday, November 28th from 6-8 PM at Dr. LaSala’s. Further details available by contacting lburns@up.uchc.edu.

Web Spotlight 1: Life in the Fast Lane

In REVIEWS on November 27, 2011 at 3:57 PM

This is the first in a new series of posts highlighting some of the best online-based EM resources that can be found. Many of these are already present in the Links section, but this series is designed to give a little more information and guidance on what is out there, with a reduction in the risk of “information overload”. So, without further ado, here we go!

Life in the Fast Lane
Summary
Format: multiauthor blog.
Authors: a group of primarily Australasian emergency physicians and intensivists. Lead authors are Mike Cadogan and Chris Nickson.
Audio/visual media?: yes, although primarily just images.
Recurring features: links to current literature of interest, clinical cases (with special series on toxicology and EKG cases), rapid Q&A based explorations of topics of interest (e.g. noninvasive ventilation), and (sometimes questionable) humor.
Why you should check it out: virtually a one-stop shop for EM education needs. Very connected to other sites as well, so you will learn more about what it out there. The recurring series are excellent, especially the Q&A based cases and overviews of interesting topics, as they give you a chance to think about the answer before actually seeing it, and can be read through in just a couple of minutes. The EKG cases are great, and while are more advanced than what we are getting in medical school, are very accessible by the writing style. One very minor point to note is that given the authors are primarily from Australia and New Zealand, there may be some slight differences in drug names/drugs used (e.g. suxamethonium vs. succinylcholine), spellings, and scope of practice (for example, it appears that there are rural GPs in Australia that seem to be able to do virtually anything) but I have not to date found this to be a significant issue.

Happy Thanksgiving!

In ANNOUNCEMENTS on November 24, 2011 at 3:52 PM

We at UCONN EMIG would like to wish everyone a happy Thanksgiving, and request you to please pass the gravy!

Journal Article Synopsis: Chronic Illness and Socioeconomics

In JOURNAL CLUB on November 20, 2011 at 7:00 AM

Summary of  “The relationship between chronic illness, chronic pain, and socioeconomic factors in the ED” by Owen Hanley, James Miner, Erik Rockswold, Michelle Biros. The American Journal of Emergency Medicine, Volume 29, Issue 3, March 2011, pp. 286-292.

With chronic health problems becoming the main focus of health care efforts and dollars in the United States there have been increased efforts to identify patient populations who are at the greatest risk for these diseases. This cross-sectional study was aimed to determine the prevalence of chronic illness and pain in the emergency department in patients of varying demographic backgrounds. Previous studies have shown that a small number of “frequent flyers” represent a substantially larger proportion of total ED visits.  Furthermore, other studies have shown that socioeconomic status and ethnicity can play an important role in ascertaining ones risk for illness, as certain populations disproportionately use emergency medical services. To appropriately address the rise of chronic health problems it is important to characterize populations at risk that are presenting to the ED. This study sought to identify these characteristics of patients that present to the ED with higher rates of chronic illness and chronic pain and to identify social mechanisms that are related to the disproportionate disease occurrence.

The study concluded that having limited access to primary care correlated with a higher perceived incidence of chronic illness, followed by family income and housing status.  The quality of a person’s environment was found to contribute the largest  to a persons perceived chronic pain as those in poor housing status reported to be in the most discomfort.

These conditions being tremendous strains on Emergency Departments across the United States raise an interesting question: can improvementsto a patients living situation and access to medical care in lower socioeconomic levels alleviate the financial and physical burden on Emergency Departments across the country?

Book Review: Goldfrank’s Manual of Toxicologic Emergencies

In REVIEWS on November 13, 2011 at 7:00 AM

This review is for the book Goldfrank’s Manual of Toxicologic Emergencies, by R.S. Hoffman, L.S. Nelson, M.A. Howland, N.A. Lewin, N.E. Flomenbaum, and L.R. Goldfrank, which can be purchased here. The reviewer has received no financial renumeration for this review.

I purchased this book and read it through the toxicology rotation due to a personal interest in the subject matter. I wanted a text that would be comprehensive and detailed, but not so long that it would not be readable within approximately a month’s time (i.e., reading the big Goldfrank’s was not a viable option), and not so abbreviated that I would feel like it was too basic. Overall, I found this book to be an excellent choice.

The text of the book is 1066 pages (not including the index). It is divided into 3 main sections: General Approach to Medical Toxicology (discussing some basic principles of approaching the poisoned patient), Fundamental Principles of Medical Toxicology (primarily organized by organ systems and discussion of special populations), and Clinical Basis of Medical Toxicology (the heart of the book, discussing individual toxins and antidotes, as well as a final section discussing disasters, poison control centers, and epidemiology). The chapters discussing individual toxins or group of related toxins are generally organized in a consistent manner, with a discussion of pharmacology, pharmacokinetics, pathophysiology, clinical manifestations, diagnostic testing, and management. Where appropriate, the chapter on the antidote follows its respective toxin.

Strengths of the book including the overall homogeneity of the book, depth of discussion with practical information including dosages on management, mostly appropriate use of tables and charts, and comprehensive range of the material. Weaknesses include occasionally too brief discussion of certain toxins and lack of references. If you are looking for a fairly definitive reference in toxicology, that is a readable length, I would recommend this book.

Overall score (out of 5 stars):

EM Images #8

In IMAGES on November 6, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

These three people all have the same condition, which can be diagnosed bedside. Note all three have extremities that are fixed in the position in which you see them. These arms can not be moved by active or passive range of motion.
The first, an older woman, and the third, a younger man, were pedestrian versus car with outstretched hands at the moment of impact. What do they have and how do you fix it and what special considerations accrue to such a diagnosis? (click below to see answers and explanation)

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