Electronic stethoscopes have been around for quite a while now, but either because of cost, difficulty of use, or simply doctors choosing the tried and true, they have not been adopted to the extend many in the industry expected. A new device slated to be released soon aims to be an intermediary turning conventional stethoscopes into powerful digital devices.
The Eko, developed by Eko Devices out of Berkeley, California, hooks up to the stem of just about any stethoscope’s chestpiece and is paired with a matching app that powers a lot of its features. It can then record exams for later review, display the visualization of the sounds, and control how the sound comes across to the listener. The app can upload recordings to an EHR or email them to another physician for review.
The company expects FDA clearance by the end of the year and is planning to start clinical trials in the SF Bay Area to evaluate the value it can offer both clinically and economically.
The company has opened a waiting list for those interested to get the Eko soon after it’s cleared and released for sale.
This patient presented with wrist pain after a fall:
This is an example of a lunate dislocation. The lunate can be seen on the lateral view (blue arrow). It is dislocated quite a far distance. Also note that the lunate is not in its usual location on the AP view.
The above radiographs are not subtle. Keep in mind that lunate dislocation is sometimes not so obvious. We visited lunate and perilunate dislocation on a prior post (lunate). Stay tuned in the future for tips on reading wrist radiographs to avoid missing any subtle injuries.
Welcome to the fourteenth edition of the #FOAMed Review! The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Each review will include highlights from the highest yield blog, podcast, video and web sources around. Over a year's span we will be sure to include topics from all core EM content areas...even the ones that may not be the coolest. Check out our indexing section #FOAMexplore which allows you to view previous #FOAMed review by edition or by selecting from CORD curriculum categories.
SUBACROMIAL BURSA INJECTION [VIDEO]: Courtesy of Dr. Larry Mellick.
ULTRASOUND GUIDED BLOCK FOR MEDIAL FOREARM [BLOG]: Excellent post from Highland Ultrasound on performing an US guided block to deliver anesthesia to the medial forearm for laceration repair or abscess drainage.
POSITIVELY PAINFUL PRIVATE PARTS [BLOG]: Three part blog series from PEM Blog on acute scrotal pain in children.
TRICYCLIC ANTIDEPRESSANTS & SODIUM CHANNEL BLOCKADE [PODCAST]: Excellent podcast review from FOAMcast covering right axis deviation and what it means, as well as delving into the management of sodium channel blockade from tricyclic antidepressant OD.
HIGH RISK BACK PAIN [BLOG]: Read about spinal epidural abscess, a rare but potentially catastrophic cause of lower back pain. You don't want to miss this.
See you next week.
#FOAMed review is brought to you by Michael Macias. If you want to recommend content you think should be added to our curriculum, send me an email, I would love to hear from you.
Any part of the male reproductive tract can hurt. One of the more common locations for pain in the Pediatric Emergency Department is the epididymis – or as I have referred to it on occasion, the “mullet of the testicle”
From wikipedia A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens
The epididymis can become inflamed and swell. This hurts. You might feel more swelling on the affected side. This is, again, better done with the standing patient. The testis will have a normal lie and the cremaster reflex is present. Approximately half of patients with epididymitis will also have scrotal edema. Some cases will present with an erythematous scrotum as well. Elevation of the testis may reduce pain – this is known as “Prehn’s sign,” but it isn’t especially sensitive or specific. There can be associated urinary symptoms like dysuria, hesitancy and urgency if the patient has a concomitant UTI or urethritis.
In terms of etiology you should first assess whether the patient is sexually active? This adds chlamydia and gonorrhea to the fray. Otherwise E.coli is the most common bacterial cause. Overall most cases don’t have an easily identifable proximate infectious provocateur. You can tell patients “it’s probably a virus,” but what do we know. There is also an association with mycoplasma, though it is limited to case series. You can make the diagnosis clinically, and obtain an ultrasound if you aren’t 100% sure. Any sexually active male should have testing for STDs (include HIV and syphilis while you’re at it) and either treat empirically or wait on your GC and chlamydial DNA studies. Prepubertal patients should be encouraged to provide a urine sample especially if they have urinary symptoms.
You may be surprised to learn that antibiotics are NOT always indicated. You should treat if:
Pyuria >5 wbc/hpf on a clean catch, positive nitrate and/or leukocyte esterase
Positive urine culture
Underlying UTI risk factors
For prepubertal males with a suspected bacterial cause use trimethoprim/sulfamethoxazole or cephalexin for 10 days. With teenagers, especially if you are considering STDs treat with Ceftriaxone 250mg IM x1 then doxycyline 100mg bid x10 days. Additional beneficial treatments include rest, NSAIDs, and scrotal elevation.
A 35 year old female presents to your Emergency department with vaginal bleeding and low abdominal pain. Her last normal menstrual period was 6 weeks ago. She is prone to recurrent vaginal spotting. She looks anxious and distressed. Vitals: BP … Continue reading →