Emergency Medicine

Back Pain

A 30-year-old male presents with a one-year history of worsening lower back pain and alternating buttock pain. He mentions his symptoms are typically worse first thing in the morning, but seem to remit later in the day with NSAIDs and exercise. Physical examination reveals swelling of the proximal interphalangeal joints of several digits, restricted lumbar movement, and tenderness of the sacroiliac joint. An X-ray demonstrates the findings seen here. Which of the following extra-articular clinical manifestations is most commonly associated with this patient’s condition?

A) Blurred vision
B) Right lower quadrant pain
C) Plaques with silver scale
D) Shortness of breath

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Deep Puncture Wounds

A 31-year-old female presents to the emergency department with deep puncture wounds on her forearm after being attacked by a pack of stray dogs. On examination, she has a loss of sensation throughout her right medial palm and fingers and she is unable to extend her fourth and fifth digits. After her wounds are irrigated, she is administered tetanus, rabies, and antibiotic prophylaxis. Based on this patient’s detected nerve damage, what other hand functions might also be impaired?

A. Finger abduction
B. Extension of wrist
C. Pinching
D. Extension of thumb

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Children with Certain Disabilities at Greater Risk of Abuse

A new study shows that children with intellectual disabilities and mental/behavioral problems are at greater risk of maltreatment than those with autism, Down syndrome or birth defects, but support for all are needed

Traffic Deaths Reach 50-Year High: Opioids and Cannabis Are Adding to the Risk

  • Deaths due to traffic collisions rose in 2015 by 7.7%—the largest increase in 1966.
  • Opioid-related overdose deaths are at epidemic levels.
  • Cannabis use is legal in 25 states.
  • The cost of these collisions and deaths is estimated at nearly $38 billion.
  • Are these phenomena related?

Selfie-Related Deaths Continue to Rise Worldwide

  • The primary cause of death during self-photography was falling.
  • Wikipedia reports nearly 60 self-photography-related deaths since 2014.
  • Physicians can remind patients how profoundly distracting and dangerous smartphones can be.
  • Remind patients to first take full view of their surroundings, then stop and pay full attention to the phone, and then put it away; They are much safer doing just one thing at a time.

Pregabalin is Safe, Cost-Effective, and Clinically Effective for Treatment of Fibromyalgia

  • Fibromyalgia etiology is complex and multifaceted.
  • Syndrome affects millions of patients worldwide.
  • Fibromyalgia has significant negative personal, interpersonal, professional, and socioeconomic repercussions.
  • While fibromyalgia is frequently recalcitrant, pregabalin has been found to be an anchor therapy for the syndrome.
  • The syndrome afflicts between 6.5 million and more than 13 million Americans.
  • Pharmacoeconomic studies have revealed that pregabalin is cost-effective.

First Dagabitran Reversal Agent Approved

  • Dabigatran anti-coagulation can now be reversed.
  • FDA approves idarucizumab for reversal of dabigatran anti-coagulation.
  • Normal coagulation is established “in minutes.”
  • Preliminary data show idarucizumab to be safe and effective for reversal of dabigatran anti-coagulation.
  • Both efficacy and safety trials are sponsored by the manufacturer and published in top-tier journals.

Heroin-Fentanyl Combo Creates Street-Drug Emergency

  • Dealers are manufacturing fentanyl in order to mix it with heroin.
  • Widespread combining and selling of illicit fentanyl with street heroin.
  • Combination produces profound euphoria and powerful addiction.
  • Combination is significantly more lethal than either drug alone.

Naloxone Kits Stop Opioid Deaths, Cost ~$70

  • At around $70 per kit, this may be the most cost-effective life-saving intervention available to physicians.
  • The opioid epidemic is arguably the most significant current public health emergency in the U.S.
  • Depending on geography, the cost of an overdose survival is ~$10,000.
  • The average cost of an overdose-related death at the MetroHealth System in Cleveland, Ohio, is approximately $3000.
  • Naloxone kit distribution programs can be run at a cost of <$1000/life saved.

Wake Up Stroke: A Brief Literature Review


  • About 25% to 30% of ischemic strokes occur during sleep.
  • Tissue-plasminogen activator is the only specific stroke treatment proven effective in large randomized trials.
  • Without knowledge of exact time of symptom onset, this large group of patients is excluded from treatment with tissue-plasminogen activator.
  • Clinical and imaging studies suggest that many wake-up strokes occur close to awakening and these patients might be within the approved time-window for thrombolysis upon arrival at the emergency department.

Improving Care of Wake-Up Stroke Patients

  • About 25% to 30% of ischemic strokes occur during sleep.
  • Tissue-plasminogen activator is the only specific stroke treatment proven effective in large randomized trials.
  • Without knowledge of exact time of symptom onset, this large group of patients is excluded from treatment with tissue-plasminogen activator.
  • Clinical and imaging studies suggest that many wake-up strokes occur close to awakening and these patients might be within the approved time-window for thrombolysis upon arrival at the ED.