Here we are, day one of Emergency Physicians Monthly's web log project. It was only a matter of time, really; this is the perfect medium for the kind of free dialogue that has always been our mission. EPM is published by a small, single-title publishing house and our editorial is built around your feedback. We are the little guy, the independent mom-and-pop corner store, but we've got big ideas. And with your help, we believe that we can bring more accountability, and eventually some positive change, to emergency medicine.
Films and Scans
a Peer-Review of Expert Witness Testimony
A patient with a history of alcoholism was brought to the emergency department by ambulance after falling five days earlier. After the fall, the patient experienced significant back pain and had been laying on a mattress in his basement. His physical examination was significant for superficial bed sores and back tenderness. His neurologic status was intact, although there is testimony that the patient developed increasing weakness in one leg before he left the ED. Spinal X-rays and CT showed fractures of the posterior body and posterior element of L1, the transverse processes of L2 and L3, and a fracture of T12 with moderate distraction of fracture fragments. The X-rays also showed findings consistent with ankylosing spondylitis.
Foreign Body? Jet the Other Nostril
No one works very long in an emergency department without running into a child with a foreign body up the nose. Sometimes things go well in your attempts at retrieval. Other times…
Anyway, here’s a trick to think about the next time you have a neurologically normal child, older than 6 months, with, say, a bead up the nose. Have the child sit up with the arms restrained.
Take a bulb syringe filled with about 7 ml of sterile saline and gently advance it up the opposite nostril until you get a good seal. Give a firm, forceful squeeze. The foreign body should come shooting out the other side.
Caveats: wear protective gear, as things can get a little messy when they come shooting out at you. Also proceed with confidence but with the strict understanding that you are only going to get one shot at this.
For the academically inclined, this technique is described in Lichenstein R, Giudice EL. Nasal wash technique for nasal foreign body removal. Pediatr Emerg Care 2000;16:59-60. Read more