Evaluation and EKG Findings with Palpitations – Primary Care RAP

Copied from Primary Care RAP March podcast - an excellent overview of the workup and "red flags" on EKG. Palpitations are a common symptom seen in the outpatient setting. While most are benign, it is important to rule out more serious and potentially deadly causes. A family history of sudden cardiac death and certain EKG… Continue reading Evaluation and EKG Findings with Palpitations – Primary Care RAP

Acute Pancreatitis

Adapted from NEJM 11/17/2016 review article "Acute Pancreatitis": CAUSES: Gallstones EtOH (must be chronic use, 4-5 drinks/d x >5y) Usu acute-on-chronic pancreatitis Binge drinking does not cause acute pancreatitis Drugs (<5%) azathioprine 6-mercaptopurine valproic acid ACEIs mesalamine Idiopathic more frequent with age NON-CAUSES: Sphincter of Oddi dysfunction Pancreas divisum Binge EtOH use (in absence of… Continue reading Acute Pancreatitis

Alpha-blockers aid in passage of kidney stones (meta-analysis)

Meta-analysis: alpha blockers effective for kidney stonesClinical Question:In patients with kidney stones (ureteric calculi), is treatmentwith an alpha blocker effective in improving passage rate and decreasingpain?Bottom Line:Although a recent large study found no benefit to alpha blocker treatment (Lancet 2015;386:341-49), this meta-analysis of 55 studies found a benefit to using alpha blockers to increase the… Continue reading Alpha-blockers aid in passage of kidney stones (meta-analysis)

Physical Therapy Does Not Benefit Simple Ankle Sprains

BMJ 2016 Nov 16;355:i5650 Most ankle sprains are simple grade 1 (stable) or 2 (mild joint laxity) sprains, but often result in some persistent impairment.  Physical therapy's role in improving recovery is unclear. n= 504 (ages 16-79) presenting with grade 1 or 2 presenting within 72 hours of injury Randomized to usual care (evaluation, home… Continue reading Physical Therapy Does Not Benefit Simple Ankle Sprains

Severe Hyperglycemia Does Not Have to Be Aggressively Managed in Well ED Patients

Ann Emerg Med 2016 Dec; 68:697 Retrospective study of 566 urban ED visits with initial glucose ≥400 mg/dL but not admitted to the hospital.  Hyperglycemia was the "CC" in half of the visits. No patients had DKA or hyperosmolar symptoms. Mean glucose at time of discharge was 334 mg/dL with wide range (48 to 694 mg/dL),… Continue reading Severe Hyperglycemia Does Not Have to Be Aggressively Managed in Well ED Patients

Pediatric Headaches – Turner

Majority of children are diagnosed with viral illness or migraine in the ED/UC setting. DDx: Infection:  viral meningitis, bacterial meningitis, orbital or cerebral abscess. Tumor:  isolated headache is a rare manifestation of a brain tumor. Intracranial hemorrhage:  non-traumatic (not typically HA alone) Carbon monoxide poisoning Hypertension:  essential, pheo Common secondary causes: fever viral meningitis pharyngitis… Continue reading Pediatric Headaches – Turner

Orbital and Preseptal Cellulitis

Nomenclature: The orbital septum defines the boundary between the orbital cavity and the skin covering the eye and orbit. Orbital cellulitis = post-septal cellulitis.  The preferred term is "orbital cellulitis." Preseptal cellulitis = peri-orbital cellulitis.  The preferred term is "preseptal cellulitis." Orbital cellulitis is a much more serious infection due to the limited space of… Continue reading Orbital and Preseptal Cellulitis