Brown Emergency Medicine Blog — BROWN EMERGENCY MEDICINE BLOG

Brown Sound: Ultrasound Diagnosis of Ectopic Pregnancy

A 36 year-old female presented with the acute onset of abdominal pain and sweating. She had taken multiple home pregnancy tests, all of which were positive, and then experienced a bout of severe dizziness. On physical exam, she was very pale, and had a flat, but tender abdomen. Soon after arrival, the patient became unresponsive, but was still breathing with rapid pulses. She was placed in reverse trendelenburg, and multiple attempts were made to get an automated blood pressure reading with no luck. Finally, a manual blood pressure of 70/58 was obtained. Fluid resuscitation was initiated and bedside ultrasound was performed…

TIPS for Managing the Acutely Agitated Patient

Emergency medicine practitioners commonly care for acutely violent or agitated patients, some of whom may be psychotic, intoxicated, or affected by another pathology. Consequently, medical personnel are more likely to experience work-place violence than police officers or prison guards, with a full 100% of ED staff experiencing verbal violence, and 35-80% reporting a history of physical violence while at work. While it is critical to initiate a work-up to diagnose the underlying cause of a patient’s behavioral dysregulation, it is of primary importance to control the patient’s behavior both for their safety and the safety of the patient’s caregivers…

Community EM, PsychiatryErica LashFebruary 18, 2020Psychiatry, altered mental status, agitation, haldol, ativan, AEIOU TIPS, safetyComment

“To Do or Not to Do an Emergency Department (ED) Resuscitative Thoracotomy”: Alternatives to ED Thoracotomy at Non-Trauma Centers

While resuscitative thoracotomy and REBOA are often viewed as heroic procedures, both carry an exorbitant amount of mortality and morbidity, and few centers around the country are able to competently offer these options. It seems appropriate to consider alternatives, especially with the emergence of bedside ultrasound and its increasing applicability in the emergency setting. PEAC or US-guided PEAC may be more feasible, performable by mostly untrained staff, and may temporize bleeding to permit transfer to definitive care.

Community EM, TraumaAndy BeckFebruary 7, 2020#FOAMed, TraumaComment

Adding Salt to the Wound

A 28-year-old male with no past medical history presents to the emergency department with two days of gradually worsening right index finger pain and swelling. The patient reports that he works on a saltwater fishing boat and frequently has cuts on his hand. A few days ago, he noticed worsening pain and swelling to a cut on his right index finger. Today, the pain worsened and he is having difficulty bending his finger. He states that the pain radiates from his index finger up his hand and right forearm. He has not had any fevers and there is no associated numbness or tingling…

Community EMAlyssa MierjeskiDecember 20, 2019Community EM, FTSComment

Brown EM Whit-ticisms: Mandible Reduction

Procedures, Orthopedics, Community EM, Whit-ticismsGuest UserNovember 22, 2019#FOAMed, Mandible ReductionComment

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