EmergencyMedicine

A short presentation looking at the epidemiology, pathology and treatment of back pain.  

Poster to help with death verification  

Shoulder Dislocations Ben Savage  

Ophthalmology Hypothetical Case Presentation & Management Ben Savage, Adam Pill Jemma Slingsby, Victoria Tuck Clement Guineberteau  

This PA Chest X-Ray demonstrates a left sided pleural effusion. In this condition fluid collects between the parietal and visceral pleura and appears as a shadowy fluid level on the X-Ray with obliteration of the costophrenic angles. If you were to examine this patient they might be in respiratory distress from reduced oxygen uptake (so have low sats, high resp rate, possible cyanosis and accessory muscle useage) - they may have reduced chest expansion on the affected side and it would be stony dull to percussion. Fluid transmits sound poorly so breath sounds would be decreased as would vocal resonance/fremitus. Someone with consolidation may have very similar clinical findings but the underlying area of lung is almost solid due to pus from the infective process - as sounds travel well through solids they would have increased vocal fremitus which is how you can clinically differentiate between the two conditions. Clinical examination and understanding of conditions is paramount to practice effective medicine. Before you recieved this X-Ray you should be able to diagnose the condition and use the X-Ray to confirm your suspicions.  

In this Chest X-Ray we can identify a left sided pneumothorax - there is absence of lung markings in the periphery and we can also see a shadow which outlines the edge of the lung. A pneumothorax is caused when air enters the potential space between the viceral and parietal pleura and causes the lung to collapse down under the pressure of it's elsatic recoil. In this case it is likely that the pneumothorax has been caused by trauma as we can see air in the soft tissues on the left side (surgical emphysema - clinically feels like bubble wrap). A pneumothorax can be a life threatening condition. The patient presents in respiratory distress with decreased expansion on the affected side. There will be hyperresonance to percussion on that side but absent breath sounds. The emergency treatment is decompression with a large bore cannula in the 2nd intercostal space mid-clavicular line followed by insertion a chest drain in the 5th intercostal space mid-axilllary line  

This is a lateral view of a Colles fracture which shows the dorsal displacement of the distal fragment. See the AP image I have uploaded for further information  

This image shows a dislocated shoulder with a fracture through the surgical neck of humerus. The patient is at high risk of axillary nerve injury. The axillary nerve supplies deltoids but this is difficult to test in these conditions - luckily it also supplies an area of skin over the shoulder known as the regimental badge - this must be tested before and after any procedure involving the shoulder.  

 

Fitness to Drive after Injury  

open fracture  

Salter Harris Classification epiphyseal injuries  

Congenital Pseudoarthrosis Clavicle  

EFAST - Extended Focused Assessment With Sonography for Trauma  

Early detection of a pneumothorax may be important in the clinical management of a trauma patient. Supine chest radiographs in the immobilized trauma patient have been shown to be insensitive.  

Central venous cannulation (CVC) is an important procedure in the practice of emergency medicine.  

Airway management in the care of the gravid patient is well within the scope of emergency medicine practice. However, it is a little explored topic in the emergency medicine literature.  

<p>Everything you need to know about the how and why to induce hypothermia in post cardiac arrest patients. We interview Dr. Scott Weingart and take a deep look into his soul to discover the platinum nugget of critical care emergency medicine.&nbsp;</p <p>Also...</p <p>-The ercast hotline is open. Give us a call at&nbsp;503-208-5680 and tell us what you have to say</p <p>-Another reason that c-diff sucks</p <p>-Your emails</p <p>And not much more</p>  

Terry OConnor talks with ercast about climbing Mt Everest and being an expedition physician<br><br>An experience with delayed sequence intubation<br><br>Rob is interviewed on <a href="http://www.skepreview.com/2010/06/interview-with-dogma-free-americas-dr.html">The Skeptical Review</a> website<br><br>A letter from Dr. Ken Walker about the international emergency medicine and the&nbsp;<a href="http://www.pfid.net/">Partners for International Development</a>