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SGEM#41: Ultra Spinal Tap (Ultrasound Guided Lumbar Puncture)

Case Scenario: A 66YO man presents with a 48hr history of fever, lethargy and headache. No significant past medical history. On physical examination he has a temperature of 38.8C, GCS 15, stiff neck on flexion and no rash. Urinalysis and CXR are normal. Laboratory testing reports an elevated WBC with a left shift. You decide he needs a LP to check for meningitis.  
thesgem.com
over 5 years ago
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Deep Space Infections of the Neck (via Emergency Medicine) | EMBlog Mayo Clinic

Dustin Leigh (@DLeigh0029) and friends just published a very comprehensive article about Deep Space Infections of the Neck in the last …  
emblog.mayo.edu
over 5 years ago
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A Broken Neck Does Not Always Mean Death - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing spinal cord injury and possible death from a broken neck. Become a friend on facebook: http://www.facebook.com/drebraheim Follow...  
youtube.com
over 5 years ago
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53

General Anatomy and Musculoskeletal System (THIEME Atlas of Anatomy)

Setting a new standard for the study of anatomy, the THIEME Atlas of Anatomy, with access to WinkingSkull.com PLUS, is more than a collection of anatomical images--it is an indispensable resource for anyone who works with the human body.Praise for the THIEME Atlas of Anatomy: General Anatomy and Musculoskeletal System: This atlas contains superior illustrations of the musculoskeletal system of the trunk, upper, and lower extremities, as well as a concise but very informative overview of general anatomical concepts. --American Association of Anatomists News Features: An innovative, user-friendly format in which each two-page spread presents a self-contained guide to a specific topic 1,700 original, full-color illustrations and 100 tables present comprehensive coverage of the musculoskeletal system, general anatomy, surface anatomy, and embryology Hundreds of clinical applications emphasize the vital link between anatomical structure and function Expertly rendered cross-sections, x-rays, and CT and MRI scans vividly demonstrate clinical anatomy Clearly labeled images help the reader easily identify each structure Summary tables appear throughout -- ideal for rapid review A scratch-off code provides access to WinkingSkull.com PLUS, an interactive online study aid, featuring over 600 full-color anatomy illustrations and radiographs, labels-on, labels-off functionality, and timed self-tests The THIEME Atlas of Anatomy series also features Neck and Internal Organs and Head and Neuroanatomy. Each atlas is available in softcover and hardcover and includes access to WinkingSkull.com PLUS.Use the General Anatomy and Musculoskeletal System Image Collection to enhance your lectures and presentations; illustrations can be easily imported into presentation software and viewed with or without labeling.  
books.google.co.uk
over 5 years ago
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Recognition of Common Childhood Malignancies - American Family Physician

Although cancer has an annual incidence of only about 150 new cases per 1 million U.S. children, it is the second leading cause of childhood deaths. Early detection and prompt therapy have the potential to reduce mortality. Leukemias, lymphomas and central nervous system tumors account for more than one half of new cancer cases in children. Early in the disease, leukemia may cause nonspecific symptoms similar to those of a viral infection. Leukemia should be suspected if persistent vague symptoms are accompanied by evidence of abnormal bleeding, bone pain, lymphadenopathy or hepatosplenomegaly. The presenting symptoms of a brain tumor may include elevated intracranial pressure, nerve abnormalities and seizures. A spinal tumor often presents with signs and symptoms of spinal cord compression. In children, lymphoma may present as one or more painless masses, often in the neck, accompanied by signs and symptoms resulting from local compression, as well as signs and symptoms of systemic disturbances, such as fever and weight loss. A neuroblastoma may arise from sympathetic nervous tissue anywhere in the body, but this tumor most often develops in the abdomen. The presentation depends on the local effects of the solid tumor and any metastases. An abdominal mass in a child may also be due to Wilms' tumor. This neoplasm may present with renal signs and symptoms, such as hypertension, hematuria and abdominal pain. A tumor of the musculoskeletal system is often first detected when trauma appears to cause pain and dysfunction out of proportion to the injury. Primary care physicians should be alert for possible presenting signs and symptoms of childhood malignancy, particularly in patients with Down syndrome or other congenital and familial conditions associated with an increased risk of cancer.  
aafp.org
over 5 years ago
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Going to work in a different country? Different culture? Different language? Avoid getting tripped up as I did!

I grew up in Belgium and went to medical school in Louvain, Belgium. I came to the USA for my internship and selected a small hospital in upstate New York. What an initial culture shock that was! The first problem was the language. I knew enough "school" English to get by, or so I thought. Talking on the phone was the hardest. Initially, the nurses in the hospital thought that I was the most conscientious intern they had ever worked with. When I was on duty and the nurses called me on the phone at night, I would always go to the ward, look over the chart, see the patient and then write a note and orders, rather than just handle things over the phone like all the other interns did when called for rather minor matters. Little did the nurses realize that the reason I would get up in the middle of the night and physically go to the ward was due to the fact that I had no idea what they were talking about. I did not understand a word of what the nurses were telling or asking me on the telephone, especially not when they were using even common American abbreviations, like PRN, QID, LMP etc. [PRN (Latin) means as needed; QID (Latin) means four times a day and LMP means last menstrual period]. That problem rapidly resolved as I began to understand more and more of the English medical terms. However, there is a major difference between understanding day-to-day common English and grasping all the idioms and sayings. A rather amusing anecdote will illustrate that. About two months into my internship, I was on call at night when one of the nurses telephoned me in the early evening. A patient (Mrs X) was having a bad headache and wanted something for it. I was proud that I had understood the problem over the phone and was even more proud that I managed to order something for her headache without having to walk over to the ward. An hour or so later, the same nurse called me for the same patient because she had been constipated and wanted something for it. Again I understood and again I was able to prescribe a laxative over the phone without having to go to see the patient. A while later the same nurse called to let me know that Mrs X was agitated and wanted something for sleep. I understood again and prescribed a sleeping pill. Close to the 11pm shift change the same nurse called me once more: "Dr. LeMaire, I am so sorry to keep bothering you about Mrs X, but she is really a pain in the neck…" Immediately some horrible thought occurred to me. Here is a patient who has a bad headache, is constipated and agitated and now has a pain in her neck. These could all be symptoms of meningitis and here I have been ordering medications over the phone for a potentially serious condition. I broke out in a cold sweat and I told the nurse "I am coming." I ran over to the ward where that patient was hospitalized, went to her room and after introducing myself said "Mrs. X, the nurse tells me that you have a pain in your neck." The rest is history. The patient lodged a complaint about the nurse and me, but we both got off with a minor reprimand and in fact somewhat of a chuckle by the administrator handling the complaint. Such tripping up by the idioms and sayings can of course happen in any language. Be aware! Dr. William LeMaire  
DR William LeMaire
over 5 years ago
Www.bmj
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Anatomy classes, but not as we know them

The University of Edinburgh’s Anatomical Museum hosted a hands-on workshop on 2 June that gave participants a chance to paint muscles, tendons, and blood vessels of the neck …  
feeds.bmj.com
over 5 years ago
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GOSFORD TRAUMA EVENING WEBCAST June 2015

Great trauma meeting webcast from Gosford Hospital, NSW, Australia! Check out the last session on cervical spine immobilisation controversies , especially on soft neck collars!  
prehospitalmed.com
over 5 years ago
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Rationale for prehospital soft neck collar use

Introduction to cervical soft collars by Queensland Ambulance Service 2015 Spinal Immobilisation_Evidence Review_170314_V3_EEM Caveats: This is a prehospital implementation by the state wide ambulance service. It doesnt mean all Emergency departments are following suit and in fact some will continue to use hard collars/Philadelphia collars etc. Yes that means soft collar will be removed on…  
prehospitalmed.com
over 5 years ago
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Torticollis: A Real Pain in the Neck - St.Emlyn's

A review of the causes and approach to patients with torticollis presenting to the ED.  
stemlynsblog.org
over 5 years ago
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Torticollis: A Real Pain in the Neck - St.Emlyn's

A review of the causes and approach to patients with torticollis presenting to the ED.  
feedproxy.google.com
about 5 years ago
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Stab Wound to the Neck with Neurogenic Shock

This week's case is written by Dr. Cheryl ffrench. She is the Simulation Director for Emergency Medicine at the University of Manitoba and is one of the advisory board members here at EMSimCases. Why it Matters Neurogenic shock is an important manifestation of spinal trauma. This case highlights several important aspects of neurogenic shock: It…  
emsimcases.com
about 5 years ago
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Imaging Case of the Week 163

The following lateral neck x-ray is from a 40 year old with fever, sore throat and difficulty swallowing. What can be seen?  
emergucate.com
about 5 years ago
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A man with generalised lymphadenopathy

A 75 year old man with Paget’s disease, hypercholesterolaemia, and hypertension presented with a three year history of multiple neck lumps, which had never been investigated and had increased in size over the past two months. He felt generally well and had no history of fever or weight loss. His appetite was normal and there was no change in bowel habit. Clinical examination showed no abnormalities and he had no shortness of breath, chest pain, lower limb oedema, joint pains, or neurological symptoms.  
feeds.bmj.com
about 5 years ago
Www.bmj
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Spinal injury in ankylosing spondylitis

A 51 year old man attended the emergency department because of a painful neck after falling from standing height while climbing out of the bath. He slipped backwards in the bath and landed heavily on his back. He didn’t remember hitting his head. He lived alone and was previously independent, although his activities had become increasingly difficult in recent years owing to ankylosing spondylitis. The neck pain worsened during the day and he attended hospital. On initial clinical examination, he was alert and communicative. He had paravertebral soft tissue discomfort at the level of the mid-cervical spine but no midline bony tenderness. His range of neck movement was limited, although this was not unusual for him. No neurological deficits were noted and he was discharged with analgesia.  
feeds.bmj.com
about 5 years ago
Www.bmj
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A pain in the neck type of headache

A 29 year old right hand dominant chef presented to the emergency department with a four day history of feeling “not normal.” He was sent home from work because of a gradual onset of dull pain on the left side of his neck radiating up into his head, which was getting progressively worse, as well as “seeing two of everything.” The pain was not influenced by changes in posture. In addition, his right side felt numb and he was dropping things at work. He felt unsteady on his feet, which prompted him to seek medical advice. He thought all his symptoms had come on suddenly and were gradually getting worse. He denied any recent alcohol consumption, illicit drug use, seizure activity, head injury, or loss of consciousness. He had no medical history of note, apart from hypothyroidism, for which he was taking thyroxine.  
feeds.bmj.com
about 5 years ago
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Imaging Case of the Week 163 Answer

The lateral neck x-ray has two findings. The epiglottis appears enlarged with a positive thumbprint sign. There also appears to be a widened prevertebral soft tissue space anterior to C3-C4. The prevertebral space measures 11 mm in front of C3 and 14 mm in front of C4. Is it epiglottitis or is it a retropharyngeal abscess?  
emergucate.com
about 5 years ago
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The Sphincter Series: Emergent Cricothyrotomy - emdocs

The Sphincter Series Part II: Scalpel to the Neck. When, Why, How, and What you Need to Perform a Cricothryotomy.  
emdocs.net
about 5 years ago
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Bert Cohen Obituary: The first Nuffield research professor of dental science at the Royal College of Surgeons of England.

Professor of dental science who undertook research into head and neck cancers.  
theguardian.com
about 5 years ago
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Dr. Aru Panwar, Head and Neck Surgery

Get to know Dr. Aru Panwar, head and neck surgery. For more about Dr. Panwar: http://doctors.nebraskamed.com/doctors/aru-panwar  
youtube.com
about 5 years ago