James Cao, MD
- Negative ultrasound doesn’t rule out disease
- Non-visualized appendix without inflammation is reassuring on CT
- Equivocal CT does not rule out disease
- Consider MRI in pregnant patients after ultrasound
Katherine Mahoney, MD
- When injury to the knee causes immediate joint dysfunction, the injury will almost always be to the ACL or PCL.
- Lateral collateral ligament injury will take up to 24 hours to swell and cause dysfunction.
- In PCL injuries and knee dislocations, careful assess for neurovascular injury.
- Unhappy triad: ACL, MCL, Medial Meniscus
- Evaluate for associated injuries in the presence of any of the three injuries.
- In addition to the 1st line treatments of calcium, insulin-d10, bicarbonate and dialysis, effective treatment of hyperkalemia involves β2-agonists; 20mg albuterol nebulized over 10 minutes or terbutaline 0.5mg IV quickly drives potassium intracellularly.
- Proper treatment of most marine envenomations, catfish being the most common, is hot water soaks for 30-90 minutes with good wound care and a quinolone or augmentin for 5 days.
- CT abd/pelvis is only 92% sensitive for small bowel obstruction. Keep an open mind if you have strong clinical suspicion.
- Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995;6(4):1134.
- Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990;38(5):869.
- Carrette TJ, Cullen M, et al. 2002. Temperature effects on box jellyfish venom, a possible treatment for envenomated patients? Med J Aust. 177: 654.
- Glenister KM, Corke CF. Infarcted intestine: a diagnostic void. Journal of Surgery 2004. 74:260
- In low-risk groups with an adequate c-spine XRay, the negative predictive value is 99.9%. However, C-spine XRay sensitivity for all comers is only 36-64% and average time-to-dispo is 1.9 hours vs 1 hour on average for CT.
- CT c-spine disadvantages: Cancer risk 1:200 in 15 y/o, 1:2,000 in 30 y/o, 1:5,000 in 70 y/o. Cost is also higher, although when inadequate CSXR and "missed fracture" costs are added in they may be comparable.
- In the alert patient with a negative CT c-spine but persistent bony tenderness there are three options: continue collar upon discharge, MRI for ligamentous injury, or flex-extension films.