A 33-year-old female presented to the ED after ingesting the mercury contained in 2,500 thermometers (about 1000 mL). It took the patient one month to purchase the thermometers in drugstores and nine hours to extract the mercury by breaking the thermometers and filtering the mercury with gauze... What do you do? A case-driven report on the treatment of massive overdoses.
Children often present to our emergency departments with buckle fractures, non-displaced fractures and minimally angulated fractures. They are often placed in casts which can be difficult to care for and then patients return to the ED for cast-related issues. This journal club will review the latest articles on the use of removable splints for fracture care in children.
It’s a bustling Saturday night and the patient in room 4 looks like a
hot appy. As she near syncopized when you suggested rectal contrast,
you’re now contemplating a non-contrasted CT scan (NCC) versus a long
drink oral contrast scan (OCC). That NCC is mighty tempting. It would
get her to the OR before the surgeon hits REM sleep and the bars close,
and there is even that recent Annals meta-analysis that suggests its
sensitivity is about 93% for appendicitis ...
Contrast protocols, including intravenous, oral and/or rectal contrast,
are just not necessary for abdominal CTs. From my perspective, the only
emergent CTs that warrant IV contrast administration are CT pulmonary
angiograms to identify pulmonary emboli, chest or abdominal CTs to
investigate suspicion for aortic dissection and perhaps for blunt
Ultrasound in the emergency medicine field has rapidly advanced over
the last few years, and its use has become standard practice for many
centers. Unfortunately, the pediatric emergency medicine world is
lagging in the advancement of ultrasound use in children.
“Doctor, I have the sickle cell.” Your eyebrows raise as the
complications of sickle cell disease run through your mind. “You mean
the disease?” you clarify. “No, I have sickle cell trait,” she
While it’s technically not a “disease,” it may be an important risk factor in the emergency department.
Manny Rivers, Brian Fuller and Kevin Klauer square off over the use of early goal-directed therapy for severe sepsis.
Pro: Research Supports It vs Con: Too Many Assumptions
Although most states are finally catching their breath from the insurgence of H1N1 seen in recent months, the second wave is coming soon. Fortunately, this break in the action provides us with the opportunity to reflect and see what we learned. Tamiflu was flying off the shelves, but did it really work? If so, which patients benefited?
Q. Given that CT imaging of head-injured children has risks of radiation-induced malignancy, are there ways to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary?
A 22-year-old male is brought to a stadium first aid station after being found running around naked at a Grateful Dead concert. He was noted to be agitated, paranoid, and visually hallucinating requiring full leather restraints. Friends of the patient claimed he ingested several “magic shrooms and blotter acid” prior to the concert.