Join EPM on the ACEP floor as we bring 

in real time.

Day One: Swimming upstream 

a Peer-Review of Expert Witness Testimony

The Case

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.

July 07:

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.