Farhad Aziz, MD
University of Kentucky Medical Center
Department of Emergency Medicine
Visual Diagnosis Part 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.
- Colle’s Fracture: In the absence of neurovascular compromise a simple sugar tong splint with slight volar angulation and orthopedic follow-up is sufficient
- Massive Pulmonary Embolism: In the setting of a massive pulmonary embolism TPA is the right choice.
- Brugada Syndrome: A sodium channelopathy that has a 10% increase mortality every year. Treated with AICD placement
- Peritonsillar abscess: Drain in ED by EM or ENT physician.
- Inferior STEMI: Leads II, III, aVF. Cath-lab or TPA depending on circumstances.
- Dental Fracture: Ellis Class III. The pulp is exposed. Cover in calcium hydroxide
- Small Bowel Obstruction: Air-fluid levels, Surgical Emergency
- Epidural Hematoma: A neurosurgical emergency. burr hole if no access to Neurosurgery
- Lisfranc Injury: High morbidity if missed/left untreated
- Cholelithiasis: In the absence of cholecystitis or cholangitis asymptomatic cholelithiasis can be treated conservatively and have out-patient follow-up with surgery.
- Chest tube: Place a chest tube in any patient decompensating from a pneumothorax before initiating positive pressure ventilation.
- 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