January 21, 2022 It's What's Inside Us

Author: Marco Propersi

PECARN Blunt Abdominal Trauma: Is A Clinical Decision Instrument Better Than Clinician Gestalt?

This post first appeared on REBEL EM Blog. Background: Unintentional injuries remain the leading cause of mortality in children. While traumatic brain injuries and thoracic traumas are the top two causes of mortality and morbidity, abdominal traumas are the third most common cause. Additionally, children are at higher risk for clinically significant intra-abdominal (IAI) injuries as a result of their anatomy in comparison to adults. Therefore, it is critical that emergency clinicians accurately diagnose IAI that requires intervention. Given the sensitivity of abdominal CTs for detecting IAI, emergency clinicians may be susceptible to overuse. Unfortunately, CTs expose patients to high doses of ionizing radiation, placing children at increased risk of developing radiation-induced malignancies. The data now shows that solid organ cancers occur in one out of every 300 to 390 girls and one out of every 670 to 690 boys undergoing abdominal CT.
The emergency medicine clinician must balance ruling out deadly diagnoses against the risk of potential radiation-induced malignancy. Prior research derived a clinical decision instrument (CDI) to support emergency clinicians using a one-way rule (Holmes 2013). According to the instrument, clinically significant injury is ruled out if none of the seven criteria are present. However, further validation of the CDI is an essential next step


Antacid Monotherapy vs GI Cocktail: Are You On or Off the Wagon?

This post first appeared on REBEl EM blog. Background: Dyspepsia and epigastric pain are common emergency department (ED) complaints affecting one in four adults annually. Twenty percent of these patients have an organic cause while 80% have functional dyspepsia (Moayyedi 2017). Antacids are often a first-line treatment in relieving the discomfort of dyspepsia and epigastric pain (Salisbury 2021). Antacids can be paired with other medications to create the “GI cocktail.”


Ultrasound-Guided Lumbar Puncture

A 68-year old obese female with a past medical history of osteoarthritis, diabetes, and cervical spinal fusion presents to the Emergency Department (ED) complaining of generalized weakness for the last week. In addition, she reports that she had cold symptoms approximately one week before the onset of her weakness. Upon further questioning, the patient also reports numbness and tingling of her bilateral lower extremities. The review of systems is otherwise negative.


Mycoplasma Pneumonia-Associated Mucositis

A 15-year-old female, with no past medical history, presented to the pediatric emergency department with cough and fever after being discharge with a diagnosis pneumonia two days prior. A chest x-ray on her first visit showed a single left lower lobe infiltrate and she was subsequently prescribed amoxicillin for suspected community acquired pneumonia (Figure 1). Upon return to emergency department, the patient complained of worsening symptoms, including dysphagia, secondary to sores in her mouth that developed after being discharge.