EMplify by EB Medicine

EMplify - October 2021

Announcements:

• The EB Medicine app is live and available for free in the Apple Store. Coming to Google Play soon. It is in Beta and your feedback is welcome. ,
• Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net

Emergency Dept. Management of Cervical Spine Injuries

Authors: 

Geoffrey Jara-Alamonte, MD

Chandni Pawar, MD

Epidemiology

Anatomy (Figure 2 +3)

Spinal Cord Injury Injury (Table1)

• Primary
• Secondary

Differential Diagnosis

Prehospital Care - selective immobilization

ED evaluations

• History
• Physical Exam (Table 6)
• Imaging
• Vascular Injury - Modified Denver Criteria (table 9)
• Treatment
• Special Populations
• Pediatrics

EMplify - September 2021

Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net !

Abnormal Uterine Bleeding in the Emergency Department

Authors:

Tazeen Abbas, MD

Abbas Husain, MD, FACEP

• Physiology review
• Terminology
• Differentiating Causes: PALM-COEIN
• Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia
• Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified
• Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise
• Age Based Differential
• 12-18
• Immaturity of the hypothalamic-pituitary- ovarian axis
• Sexually transmitted infections
• Coagulopathies, and bleeding disorders (von Willibrand disease)
• 19-39
• polyps
• fibroids
• malignancy
• PCOS
• Age 40 and older
• endometrial atrophy
• malignancy
• History
• Physical Exam
• Diagnostic Studies
• Treatment
• Unstable
• Stable
• Special Cases
• DOACs
• Prepubescent girls
• genital injuries

EMplify – August 2021

Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !!

August 2021 Pediatric Emergency Medicine Practice

Less Lethal Law Enforcement Weapons

Authors: Jessica Osterman, MD , Cara Buchanan, MD

What kinds of less-lethal weapons are law enforcement using?

• Pepper spray
• Conducted Electrical Weapons (CEWs)
• K-9s
• Beanbag guns
• Rubber bullets
• Stingballs

Differential Diagnosis

Prehospital Care

Trauma Informed Care

Conductive Electrical Weapons – Taser

Chemical Irritants- Pepper Spray, Tear Gas

K9 Injuries

Kinetic Impact Projectiles- Rubber Bullets, Beanbags, Sting Balls/Grenades

Sounds:

Police Siren https://freesound.org/people/MultiMax2121/sounds/156869/

Ambulance https://freesound.org/people/sofialomba/sounds/469413/

Angry Man https://freesound.org/people/ebcrosby/sounds/334439/

Taser https://freesound.org/people/The_Chemical_Workshop/sounds/403252/

Taser https://freesound.org/people/Greub/sounds/402636

Coughs https://freesound.org/people/freesound/sounds/25301/

Dog Bark https://freesound.org/people/ivolipa/sounds/337101/

Grenade https://freesound.org/people/superfreq/sounds/268101/

Last Updated on April 29, 2022

EMplify – July 2021

Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !!

HIV- An Interview With Dr. Daniel Egan

See the EB Medicine Article @ https://www.ebmedicine.net/topics/infectious-disease/HIV

• Why HIV? 
• 2018 , 1,2 million people living with HIV, almost 40k new infections
• People living with HIV visit the ED 3 x per year on average
• HIV infected patients accounted for 6 in 1000 ED visits in 2017
• New Transmission of HIV, Figure 1
• What does acute infection look like ?
• What about chronic infection ?The chronic phase can last 10 years or more and be asymptomatic.
• Are people with HIV more likely to develop: CAD, COPD, DVT and why?
• What if they are on medication for HIV?
• Screening in the ED, everyone? Do they have to have symptoms or risks?
• What does universal screening mean?
• What does risk based screening mean?
• What are the risk factors? What if I see someone on PrEP who is in the ED for an unrelated complaint?
• History
• Ask about cd4 and viral load and last test
• Ask about he of opportunistic infections
• Ask about medication side effects
• What else?
• Exam
• Labs – rapid testing, 4th gen, viral load and cd4, etc
• Imaging
• Treatment
• Table 1
• Highly effective and reduces transmission
• Medication side effects (we don’t have to dwell on each Med and side effect and just reference the charts)
• hep B virus deactivation
• System Based Disease
• Heart Failure and CAD
• PCP (role of LDH)
• TB
• COPD
• Renal Disease – stones , radiolucent
• Neurologic- CVA, cryptococcal meningitis, toxo, progressive multi focal leukoencephalopathy, HAND
• GI – diarrhea causes, c diff, hep C
• Heme- cytopenia
• Endocrine – metabolic syndrome
• Musculoskeletal
• Psychiatric table 3
• Derm
• Special Circumstances
• PEP
• PrEP

EMplify - June 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Syncope- An Interview With Dr. James Morris See the EB Medicine Article @ https://www.ebmedicine.net/topics/cardiovascular/syncope Why syncope? Prevalence, hospitalizations, etc. Etiology: figure 1 is fantastic. Physiologic basis of syncope Neurally mediated Orthostatic - are we still doing orthostatic vitals in the ED? Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Prehospital care is all about details What did bystanders see? What do paramedics see? Any trauma? Any neuro deficits ? Glucose ECG ED History - table 4 History of similar Prodrome Associated symptoms (chest pain, neuro symptoms, etc) Falls Pre-syncope ? ED exam Vitals, vitals, vitals Orthostatic vitals ? Carotid sinus massage, why this? Do we do in the ED? ECG Brugada, blocks, VT, ST changes, etc Labs BNP, delta bnp ? Trop Lactic acid Pregnancy test CBC lutes Bun/Cr Echo - any role in the ED? CT Head PE- get this on everyone ? Is it high prevalence? Risk stratification tools- the bad and the worse Table 7, amazing Controversies Admitting the elderly Orthostatic vitals (we discussed already) Disposition