![]() Key ligaments
Fracture Classification - Young-Burgess
Pelvic ring injuries
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![]() Acute Otitis Externa
Cerumen Impaction Options
Foreign Body Removal
Acute Otitis Media
![]() Basic Tips
![]() Acquired Long QT
Bad Trauma Airway (Cricothyroidotomy, Traumatic Brain Injury
Occult Hip Fracture
![]() Basics
Some Concerning History?
Migraine
Consider Imaging for:
Treatments for benign HA
![]() 1. Sensitivity and specificity of treadmill, echo, and myocardial perfusion stress testing: * Treadmill Sn: 68%, Sp 77%. * Dobutamine Stress Echo: Sn 81%, Sp 80%. * Myocardial Perfusion: Sn 87%, Sp 73%. 2. 50% of the plaques that rupture and cause AMI/ACS are <50% stenoses, and are generally not detected on stress testing. A NEGATIVE STRESS TEST DOES NOT RULE OUT ACS! * For this reason, if the clinical history is concerning, no prior stress test should be reassuring, regardless of how recent. 3. AHA recommendations on stress testing are based on "very limited" evidence. Particular populations where utility is limited: * Patients <40 years old. * Patients with recent (last 14 days) cocaine use. Journal of EM 2004 (Littmann) - All stress tests were positive, but all of their caths were normal. Deemed false positive stress test for up to 2 weeks. ![]() Some Thoughts to Keep in Mind
Calcium Score
![]() CASE 1 - Pupura, Diffuse Lymphadenopathy, Fatigue, Arthralgia, 20lb weight Loss. DDx: HUGE and includes: HIV/AIDs, syphilis, tick borne disease, endocarditis, meningococcemia, thrombocytopenia Core Concept: LUPUS
CASE 2 - 55yo with n/v/d after eating fast food. Hx of previous CVA, TIAs, and Mitral Valve Repair. Is this Acute Gastroenteritis? Nope - Imaging: right vertebral artery occlusion with posterior CVA. Core Concepts: Posterior CVA
CASE 3 - Teenager with complains of persistent shoulder pain, Normal x-rays, Tachycardic. Later found to have Hypoxia!
Initially he looked well... then he didn't. Found to have CA-MRSA subperiosteal abscess. Core Concepts - CA-MRSA
![]() BASICS
DIAGNOSIS
SIZE MATTERS
MANAGEMENT
![]() Integrity - EM physician integrity is under attack
Hospital system -Hospital is venue to admit and provide tools and tech for doctors to work. -Need hospital based specialists (such as ER physician) -Older system - sign exclusive contract to allow doc to see patients in hospital; hospital provides space and support staff. -Contract holders: Small group, single person, corporation Potential for trouble: Contract holder wants to pay physicians as little as possible, hire the most unqualified physician, and control doctors with ability to fire troublemakers and incur penalties for leaving.
Coercion
Corporate Practice of Medicine
How to protect EM Physicians
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