The Bind When it Comes to Using a Binder

Originally posted on The Collective:

This post by Dr Alan Garner is the first of a trio on the topic of pelvic fractures and the evidence for what to do. Alan is an emergency physician at Nepean Hospital in Sydney and the Medical Director of CareFlight, having started in prehospital medicine in 1996. He has a bunch of other interests but there’s not enough space for that here.

Unfortunately I am old enough to remember when MAST suits were considered standard of care. In many states of the US it was law that ambulances had to carry them – that is how convinced everyone was that the things were doing good, not evil. We were all misled by measuring surrogates of outcome such as blood pressure rather than the outcomes that really matter, morbidity and mortality. Of course when good studies evaluating mortality were eventually done we discovered the evil side of the device and…

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PHARM PODCAST 107 : Prehospital airway Part 2

Here is an intubation we prepared earlier

Here is an intubation we prepared earlier

Hi Folks

On today’s show, I deliver Part TWO of a Two part podcast on Prehospital Airway.

Show note references:

Register for SMACC please!

 

  1. Now, onto the PODCAST!

    Right

    Click and Choose Save-as to Download the

    Podcast.


Filed under: airway, Emergency medicine and critical care, FOAMEd, Interviews of interesting people, Online critical airway training, prehospital and retrieval medicine podcast, Prehospital medicine Tagged: airway, itunes, prehospital

Intermittent Visual Symptoms

57 yo M with PMHx of uncontrolled DM and HTN who presents with 3 weeks of intermittent  visual problems. Patient reports he sees visual distortion, characterized by flashes on both of his left sides of vision in both eyes. He is also unable to process 3D spacing and has trouble walking and reading due to vision problems. Episodes of symptoms tend to last 3-4 hours. Additionally patients complaints of mild R parietal headache that usually coincides with visual symptoms. Denies weakness or sensation deficits, dizziness, seizures or fever.

Physical examination in the ED is remarkable for absent vision on both left sides of his visual fields. Detailed eye and neurological exam reveal no additional abnormalities

Labs are only remarkable for hyperglycemia of 60 mg/dl, with no ketones or acidemia.

Hemianopsia

 

 

 

 

 

Management of hyperglycemia did not improve symptoms.

Brain CT and MRI were performed showing no abnormalities that could explain clinical picture.

What is the name of this patient’s deficit and where is anatomically located ?

Answer: left side , homonymous hemianopia and damage is located anywhere along the retrochiasmal visual pathway

Homonymous hemianopia is hemianopic visual field loss on the same side of both eyes occurring with with complete lesions anywhere along the retrochiasmal visual pathway (see picture)

Visual pathways / anatomic correlation of deficits

The patient was admitted to neurology service. Given negative neuroimaging, an EEG was perfomed to assess for focal seizure activity.

EEG showed multiple R occipital lobe seizures, that correlated clinically with patient’s intermittent focal visual deficits. Patient was loaded with IV Keppra and then started on 750 mg BID with resolution of symptoms.

Zhang X, Kedar S, Lynn MJ, Newman NJ, Biousse V. Homonymous hemianopias: clinical-anatomic correlations in 904 cases. Neurology. 2006;66(6):906.

Thank you Dr. Schnapp for an interesting case.

Lidocaina endovena e ischemia acuta degli arti

Cercando qua e la nel mio aggregatore di FEED qualche spunto interessante per il blog, mi sono imbattuto in questo articolo recentemente pubblicato su Emergency Medicine Joournal: Comparison of intravenous lidocaine versus morphine in alleviating pain in patients with critical limb ischaemia. Ammetto di essermi molto stupito. Lidocaina endovena per il trattamento del dolore da ischemia […]

The post Lidocaina endovena e ischemia acuta degli arti appeared first on EM Pills.

EP Report back on this case: a very fast narrow complex rhythm followed by a very fast wide complex

This was a very interesting case:

A Very Fast Regular Narrow Complex, Followed by an Equally Fast Regular Wide Complex

It had a very fast narrow complex rhythm, then a very fast wide complex rhythm, then converted to sinus with a very short PR interval.

We surmised that there must be accelerated AV conduction AND an accessory pathway.

The EP results are back, and:

1. Accelerated AV conduction
2. Left lateral accessary pathway.  It was ablated.