Take Home Points Key point is to discern between central and peripheral causes – become familiar with the nuances of one and concentrate on that Assume central and convince yourself its peripheral in nature, if at the end of the evaluation, you can’t do that, assume a central cause and do a work-up Using timing ... Read more

Take Home Points Examine all parts of the body, even inside the mouth – this can be the difference between benign and life threatening rashes Truly emergent causes: meningococcemia, TTP, DIC, TSS, SJS, TEN, and necrotizing fasciitis Toxic appearing patients with petechia/purpura = sepsis until proven otherwise Look for medication reactions: Sulfa, Penicillins, NSAID’s, ABX, ... Read more

Take Home Points Look for the red flags – hypotension, environmental exposures, medications (SS, NMS), SIRS/qSOFA criteria Be on the lookout for neutropenic fever – isolate patients, administer abx early, and admit Sepsis definition is changing all the time – be aware of current guidelines Remove pre-existing indwelling lines/catheters in the setting of sepsis – ... Read more

Take Home Points Sprains need more support than just an ace wrap – place them in an aircast or a splint Perform a thorough physical exam – take off their shoes and socks Lisfranc and Maisonneuve injuries are often missed – make sure to exam the bottom of the foot for echymosis, eval for mid ... Read more

Take Home Points Approach leg pain with the seconds, minutes, hours mindset – think about acute limb ischemia, compartment syndrome, and necrotizing fasciitis Do a thorough physical exam – get their shoes and socks off – you will find crazy stuff when you actually look Palpate and image the joint above and below any injury ... Read more

Take Home Points Don’t make bite width to small – look at the curvature of the needle – start the bite at half the curvature of the needle Don’t pull too tight – this will pucker the skin and lead to poor healing due to ischemia at the wound borders Laceration repairs are not sterile! ... Read more

Take Home Points Ask about the red flags: cancer, fever, IVDA, FND, point tenderness, saddle/perianal anesthesia, trauma, urinary retention, bowel incontinence, weight loss Most don’t need XR’s – set this expectation and advise against bed rest Consider XR’s: h/o cancer, extremes of age, osteoporosis, new back pain in the elderly, trauma Perform POCUS and check ... Read more

Take Home Points Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise Confirm vaginal vs rectal bleeding – it can be hard for patients to tell, especially the elderly Quantify the amount of blood loss – soaking thru >1 pad/hr is a lot Ask ... Read more

Take Home Points Get a upreg on every female patient of child bearing age with lower abdominal pain – this is an ectopic pregnancy until proven otherwise Always consider ovarian/testicular pathology for lower abdominal pain Always have a chaperone when performing genitourinary physical exams Ovarian cysts >5 cm are at high risk for torsion, consider ... Read more

Take Home Points Diffuse abdominal pain can be anything – keep a broad differential and work from there Old patient and flank pain = aortic catastrophe – aortic dissections and aneurysms can knock off flow to the kidneys Appendicitis and diverticulitis can presents diffusely early in their clinical presentation before they localize Kidney stones are ... Read more