Hip injury presenting as knee pain Pitfall: Hip injury presenting as knee pain! is a critical concept in clinical practice, necessitating a thorough examination to identify the underlying cause. Common areas of referred pain include the hip and knee, where hip conditions can manifest as knee discomfort. often presents with knee pain, making it essential to evaluate the hip. In the elderly, can lead to medial knee pain, highlighting the need for careful assessment. Clinical Pearl: Always examine the joints above and below the site of maximal pain. For instance, in older patients with medial kne ..read more

Give NAC if level is above 150 mcg/mL four hours post-ingestion Initial loading dose of NAC is 150 mg/kg IV (140 mg/kg PO) Paracetamol (acetaminophen) is commonly used for pain relief and fever reduction in children. It's found in many over-the-counter and prescription products. Paracetamol overdose is the most common toxicological emergency. Screening for paracetamol should occur in all overdose cases. Excess paracetamol is metabolized via the cytochrome P-450 pathway in the liver. This produces a toxic metabolite called N-acetyl-p-benzoquinone imine (NAPQI). Glutathione stores in the liver a ..read more

Shock is defined as a life-threatening condition characterized by inadequate oxygen delivery to tissues, which leads to cellular and tissue hypoxia. This state can result from various underlying mechanisms, including reduced blood flow, decreased circulating volume, impaired cardiac function, or vascular dysregulation. Shock is commonly classified into four main types: Hypovolemic Shock: Caused by significant loss of blood volume, such as from hemorrhage or severe dehydration. Cardiogenic Shock: Results from the heart's inability to pump effectively, often due to conditions like myocardial inf ..read more

Increased intracranial pressure (ICP) is a serious complication of head injuries and can lead to poor outcomes if not managed appropriately.  The Monro-Kellie doctrine states that the skull is a rigid container, and any increase in volume within this container (brain, blood, or CSF) will result in a rise in ICP. Therefore, management of increased ICP focuses on reducing intracranial volume.  Hyperventilation, although controversial, can be used in moderation (PaCO2 of 35-40 mmHg) to induce cerebral vasoconstriction and reduce intracranial blood volume acutely.  Mannitol, an osmo ..read more

Tissue Glue Eye Injury (Cyanoacrylate Tarsorrhaphy) Emergency providers frequently utilize tissue adhesives like cyanoacrylate glues for wound closure, especially in pediatric patients where sutures can be challenging.  However, these compounds can inadvertently end up in unintended areas if the patient moves unexpectedly during the application process.  The term "cyanoacrylate adhesive tarsorrhaphy" refers to inadvertent gluing of the eyelids by cyanoacrylate.  It's important to act quickly but remain calm.  Eye irrigation along with manual removal of adhesive debris can h ..read more

Escherichia coli O157:H7 is a pathogenic strain of E. coli known for causing severe gastrointestinal illness in humans through consumption of contaminated and raw food, including raw milk and undercooked ground beef. This bacterium is notable for producing a potent toxin called Shiga toxin, which is responsible for the characteristic symptoms associated with E. coli O157:H7 infection. Patients infected with E. coli O157:H7 typically exhibit symptoms like bloody diarrhea, abdominal cramps, and occasionally fever. In severe cases, the infection can progress to hemolytic uremic syndrome (HUS), a ..read more

Scombroid poisoning is caused by consuming improperly refrigerated fish. Scombroid is the common term for histamine fish poisoning.  It gets its name from the family of fish Scombridae such as tuna and mackerel, which typically cause the poisoning.  However, a large variety of fish can cause scombroid, most of them dark meat fish.  These fish have high levels of histidine in the meat.  If the meat is improperly refrigerated, bacteria on the surface of the meat convert histidine to histamine, which is the principal cause of the symptoms. Common fish causing scombroid include ..read more

* The supine position is when a person lies on their back with their face looking up.  * This is the most common position for medical examinations and procedures. * The prone position is when a person lies on their stomach.  * This position is sometimes used for medical procedures, such as surgery on the back. * The lateral position is when a person lies on their side.  * It is commonly used for sleeping but can also be used for medical procedures.  * The left lateral position is preferred for pregnant women because it improves blood flow to the uterus and baby. * The semi ..read more

Remind yourself why you do what you do: It's important to stay connected to your purpose and find1 meaning in your work. Find a hobby: Hobbies can provide a fun and relaxing way to de-stress. Spend time with loved ones: Social connection is important for mental health. Make time for exercise and sleep: Exercise and sleep are essential for both physical and mental health. Take a vacation: Breaks from work are essential for preventing burnout. Find support in the workplace: Having a good friend or mentor at work can provide emotional support and help you feel less isolated. Set personal goals: H ..read more

One mnemonic for potentially reversible causes of traumatic cardiac arrest is the acronym H.O.T.T., which stands for Hypovolemia, Oxygenation impairment, Tension pneumothorax, and Tamponade of the pericardium. Hypovolemia (H) in trauma is almost exclusively caused by hemorrhage and is the most common, potentially reversible cause of traumatic cardiac arrest.  Impairment of oxygenation (O) often requires the creation of a patent airway and optimizing oxygen supply.  A tension pneumothorax (T) may present in spontaneously breathing patients, but also rapidly develop after endotracheal ..read more