by Michael Simoes, M.D.   Background About 50% of patients with cirrhosis have gastroesophageal varices, and the presence of them is associated with severity of liver disease. The Child-Pugh scoring system is often used to predict mortality. For example, Child’s B and C cirrhosis will have a greater rate of variceal hemorrhage, recurrent bleeding, larger varices, and higher risk of failure to control bleeding. While there have been significant advancements in management of cirrhosis, portal hypertension, and prevention of variceal bleeding, there are times in which temporizing meas ..read more

It’s that time of year, the pediatric ED is filled with bronchiolitis. Let’s review what bronchiolitis is and how to manage this condition. What is bronchiolitis? Bronchiolitis: Umbrella term for viral URI causing cough/congestion and lung mucus and inflammation leading to trouble breathing and wheezing in children under age 2 years old.  RSV is the most common cause, however all viruses can cause bronchiolitis.  Bronchiolitis is typically seen in the winter months or “flu season”, though in Florida we seem to see it nearly year-round! Viruses that cause this are easily spread by co ..read more

by Justin Arnold, DO, MPH, FACEP, FACMT Although us Floridian’s don’t have the freezing cold weather necessitating a nice fire in the fireplace or space heaters in every room, we still see victims of housefires presenting to our ED.  In fact, Florida has the third-highest number of properties at risk for fire due to natural disasters including hurricanes, flooding, and wildfires – only Texas and California pose more risk. CYANIDE AND HOUSEFIRES And though we certainly worry about thermal burns associated with a housefire, the culprit of those that succumb to a housefire is by and large ..read more

by Allyson Hansen, D.O. & Charlotte Derr, MD, RDMS, FACEP Image you’re working in a solo community shop! A 45-year-old female comes to the ED with a left shoulder deformity and severe pain after speeding through downtown Tampa on an electric scooter for which she lost control. Unfortunately, she crashed into the sidewalk onto her left shoulder. X-ray displays a shoulder dislocation, just as you suspected! The patient says she has HTN, HLD and you note a BMI of 40. She was recently started on Ozempic, a GLP-1receptor agonist. As usual, you think of the various offerings to assist with reduc ..read more

Clinical simulation can help improve quality and patient safety in healthcare. “Hybrid learning,” according to Dr. Paul E. Phrampus, FACEP, FSSH, CPE, is defined as a combination of online educational materials and in-person learning, and this design can enhance the efficiency and effectiveness of simulation-based curriculum. Pre-work can be created de novo or it can be assigned from another source, if appropriate. By preparing for in-person simulation with pre-work, learners can be more prepared for and can engage in the simulation with a higher level of knowledge and critical thinking. When ..read more

Lance Lewis, MD and Allyson Hansen, DO Overview Cricothyrotomy is a rarely performed procedure by the emergency physician, but can be life- saving and is critical to know. Compound this with physician nerves and a non-ideal airway anatomy secondary to body habitus and trauma, this can be a difficult procedure to perform! Thankfully, ultrasound can be used as an adjunct to properly identify airway anatomy. Image 1 (1). The cricothyroid membrane can be identified between the thyroid cartilage and the cricoid cartilage, which can be seen in the longitudinal picture below. Thyroid cartilage is a ..read more

Enola Okonkwo, MD; Nicholas Lewis, BS; Claire Dalby, BA; Lorena Martinez, DO INTRODUCTION This blog post is going to focus on microangiopathic hemolytic anemias (MAHA) – namely, three major conditions characterized by microangiopathic hemolytic anemia: Thrombotic Thrombocytopenic Purpura (TTP), Hemolytic Uremic Syndrome (HUS), and Disseminated Intravascular Coagulation (DIC). These conditions should be added to the “Can’t Miss List” for Emergency Physicians. If you’re a medical student or physician who struggles to keep these conditions straight, you are not alone!  However, understandin ..read more

POCUS for Diagnosing Lower Extremity DVT in ED Jennifer Shin, MD Top Takeaways: 1. When performing a bedside DVT ultrasound, 3-point compression protocol is preferred and emphasizes areas at risk of DVT 2.  Thrombus may be anechoic (acute) vs. echogenic (subacute, chronic) 3. Non-compressible? No echogenic clot? Color flow + Squeeze calf = Perform augmentation! 5. Treatment of DVT and what to do for a moderate/high-risk patient with negative DVT study = repeat scan  Why do We Care? Deep vein thrombosis (DVT) is a thrombus that forms within the deep peripheral veins. Venous stasis, e ..read more

Dr. Gillen and colleagues recently published a case report on a rare type of hypertrophic cardiomyopathy, Yamaguchi variant. Many of us are familiar with hypertrophic cardiomyopathy, which is typically characterized by large voltage ECGs with dagger q waves, but you may not be aware that there are actually multiple subtypes of hypertrophic cardiomyopathy that may also have serious implications and can be more difficult to recognize. Yamaguchi syndrome, is one such subtype that is characterized by apical hypertrophy which can cause deep inverted t waves on ecg. Abnormal inverted t waves seen i ..read more

Alexander Vanfleet, Allyson Hansen TLDR 1.     Peritonsillar abscess (PTA) is the most common deep head/neck space infection presenting to the Emergency Department, with an incidence of approximately 1 in 10,000 patients. 2.     Use of Ultrasound is on the rise for PTA (25% in 2007-2008, 78% in 2013-2014) with associated improvement of Emergency physician success and decrease in ENT consults, CT usage, return visits, and LOS. 3.     We reviewed our case, including our “I&D Preparation” with a step-by-step breakdown of how to effi ..read more