Welcome Ahmer Khan from UT Southwestern / Parkland, our new Sports Medicine Fellow for 2014-2015!

David Milzman, MD is the new Assistant Dean for Student Research at the Georgetown University School of Medicine.  He will remain an integral part of our ED research team as the Director of Brain Trauma Research.

Munish Goyal, MD will assume the role of Research Director for the Department of Emergency Medicine.

We are in the process of finalizing the details for our new Health Care Policy Fellowship, with a projected start date in July 2015 -- more news to follow in the months ahead.

Congratulations to Drs. Matt Wilson and Dave Milzman for their publication in Wilderness & Environmental Medicine:
Injury Patterns in Recreational Alpine Skiing and Snowboarding at a Mountainside Clinic. December 2013.

Congratulations to Drs. Matt Wilson, Bill Frohna, and Diane Sauter for their article in press in the Annals of Asthma, Allergy, and Immunology: Evaluating for seasonal variation in angiotensin-converting enzyme inhibitor–and angiotensin receptor blocker-induced angioedema. 16 December 2013

Some of our residents enjoying dinner together

Lower Extremity and Pelvic Injuries                            Elizabeth Delasobera, MD, Program Director, Sports Medicine Fellowship

• 50% of pelvic fracture require a transfusion.  Always perform a FAST exam to look for blood around the bladder.
• Hip Dislocations:  risk of avascular necrosis increases significantly after 6 hours.
• Simple neuro exam in back pain:

1. ​L4: ankle inversion, sensation of medial surface of foot
2. L5 great toe dorsiflexion, sensation in 1st web space
3. S1 ankle eversion, sensation of lateral surface of foot

Acute Angle Closure Glaucoma                                        Daisi Choi, MD, PGY-2

• Exam findings: hazy cornea, conjunctival injection, mid-fixed pupils, and increased intraocular pressure
• Treatment:

1. T: Timalol to decrease aqueous humor production
2. A: Apraclonidine to decrease aqueous humor production
3. M: Mannitol to shift aqueous humor
4. P: Pilocarpine to increase aqueous humor drainage
5. A: Acetazolamide to reduce aqueous humor production

• Mannitol and Pilocarpine should be given after use of other three agents, with optho consultation

Pediatric Fever Risk Stratification                                        Whitney Cabey, MD, Adult and Pediatric EM Faculty Attending

• Think of your pediatric patients with fever without a source as high risk versus low risk, not bacterial versus viral.  Here is a recommended review article.  And one more.
• Familiarize yourself with the risk stratification/low risk criteria for SBI and implement one in your practice.  Recommended review article and another with tables
• When in doubt, check the urine.  Follow that, but know it may be soon changing.

A 62yo F with history of DM and CAD with prior stent placement presents with respiratory distress and chest pain for one day.

Vitals: HR 141, BP 163/98, Temp 37.1, O2 Sat 95% on RA

Exam: Alert, anxious appearing. CV was regular, tachycardic, no murmurs.  Lungs clear bilaterally.  Trace bilateral lower extremity edema

What would you do?  Click here to see a prior ECG and what happened

Thank you Dr. David Hager for providing this interesting case!

ULTRASOUND REVIEW

38 yo M with DM and IBS presents with shortness of breath, right sided chest pain, and productive cough for two days with foul smelling sputum. He was recently hospitalized elsewhere with an E. coli liver abscess s/p percutaneous drain.  He was discharged home with the drain and received IV ceftriaxone through a PICC line. He completed antibiotics 3 weeks prior and his PICC line was removed. He denies fevers, chills, hx of HIV or TB.

VS: T 37, P 108, RR 18, BP 118/70, 100% RA

Exam: Moderate distress due to constant cough, bringing up purulent, foul smelling sputum, lung sounds absent in lower half of right lung, Tachy no m/r/g, abd normal

Labs: WBC 13.7, Hgb 10.7, Hct 32.9, Plt 811, Neutr % 81.4, Na 134, K 5.0, Cl 98, CO2 29, BUN 7, Cr 0.62, Glu 145, AST 10, ALT 29, AlkP 247, Bili dir 0.25, lactate 1.3, PT 15.8, INR 1.3,

EKG: Sinus tach at 104

Click here for the US and CXR, and a review of the US findings

Thank you Dr. Judy Lin, Ultrasound Fellow, for this presentation!

Dr. Herzberg (left) along with our EMS colleagues raising money for muscular dystrophy during EMS week