Visual Diagnosis: Part 1

Visual Diagnosis

Part 1

Farhad Aziz, MD

University of Kentucky Medical Center

Department of Emergency Medicine

____

 Visual Diagnosis Part 1

Answers

Explanation:

  1. Tension Pneumothorax: Note the tracheal and mediastinal deviation in the setting of a pneumothorax. Even though it makes more clinical sense to do a finger thoracostomy followed by a chest tube in this patient, for the boards a needle decompression is ALWAYS the answer.
  2. Colle’s Fracture: In the absence of neurovascular compromise a simple sugar tong splint with slight volar angulation and orthopedic follow-up is sufficient
  3. Massive Pulmonary Embolism: In the setting of a massive pulmonary embolism TPA is the right choice.
  4. Brugada Syndrome: A sodium channelopathy that has a 10% increase mortality every year. Treated with AICD placement
  5. Peritonsillar abscess: Drain in ED by EM or ENT physician.
  6. Inferior STEMI: Leads II, III, aVF. Cath-lab or TPA depending on circumstances.
  7. Dental Fracture: Ellis Class III. The pulp is exposed. Cover in calcium hydroxide
  8. Small Bowel Obstruction: Air-fluid levels, Surgical Emergency
  9. Epidural Hematoma: A neurosurgical emergency. burr hole if no access to Neurosurgery
  10. Lisfranc Injury: High morbidity if missed/left untreated
  11. Cholelithiasis: In the absence of cholecystitis or cholangitis asymptomatic cholelithiasis can be treated conservatively and have out-patient follow-up with surgery.
  12. Chest tube: Place a chest tube in any patient decompensating from a pneumothorax before initiating positive pressure ventilation.
  13. Transfer for PCA: Inferior STEMI. After first medical contact, a patient should receive PCA within 90 min at the initial hospital or within 120 min if a transfer is required.

Beyond The Boards

  1. LITFL: Brugada Syndrome
  2. EMin5:Dental Trauma
  3. EMCRIT: Massive PE

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