Necrotizing Soft Tissue Infections

A 44 year old female presented to a community emergency department complaining of an abscess on her lateral right thigh that had been increasing in size for the last 2 days.  She reported having been kicked in that leg a few days prior.  She had been not been febrile, but did report some generalized malaise.  Her medical history was remarkable for chronic Hepatitis C without cirrhosis and a remote history of IV drug use, though patient strongly denied any recent use and had no apparent active injection marks.  Physical exam showed a 4 cm abscess on the lateral right thigh, roughly 2/3 of the way between the greater trochanter and the knee, with about 10 cm of associated cellulitis. Incision and drainage was performed and the patient was prescribed analgesics and trimethoprim/sulfamethoxazole.  The margins of the cellulitis were marked and the patient was instructed to follow up for wound check the following day.   Continue reading

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… but shouldn’t we start transfusing him?

I was initially going to do something on chest pain but that will be pushed back for a quick discussion on when to transfuse patients in the ED.  While most of this information can be generalized to any patient actively bleeding I will focus on the patient with GI hemorrhage with some literature hot off the press. Continue reading

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Anterior Shoulder Dislocation Complications/Reduction Complications

antshouldAnterior shoulder dislocations are very common and we all have our favorite ways to reduce them.  I’ve noticed lately, however, that many residents don’t know what complications to look out for and what to do if they find them.  The Hill-Sachs deformity and Bankart lesion are the most common dislocation complications, with axillary nerve injury being the most discussed complication of reduction.

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Calling STEMI

ekgHow good are physicians at calling STEMI? After reading Dr. Smiths “Can’t miss ECGs” in EM Resident Dec/Jan 2013 vol. 39, issue 6, I decided to look further into the accuracy of physicians to call STEMI. Continue reading

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