Not Another Patient with Dizziness! - Evidence Based Pearls for Your Practice

Not Another Patient with Dizziness! - Evidence Based Pearls for Your Practice

Dizziness accounts for 4-5% of all emergency department (ED) chief complaints and 26% of ED patients endorse dizziness in their review of systems.  Although most presentations for dizziness are benign, nearly 200,000 strokes present with dizziness each year in the United States (Edlow et al. 2008).   Misdiagnosis of vertebrobasilar strokes is common, as symptoms may be minimal and patients often change how they characterize their symptoms.  In the video below, Dr. Siket covers a systematic and evidence based approach to guide your workup of this all too common patient.  

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Bud's Common and Simples - Intra-nasal Foreign Bodies

Bud's Common and Simples - Intra-nasal Foreign Bodies

You stuck what where?!?!   Dr. George "Bud" Higgins shares with us some tricks of the trade regarding evaluating and removing intra-nasal foreign bodies. He discusses some well known maneuvers ("parent's kiss," passing a foley catheter, bayonette forceps) and a more novel approach using intranasal positive pressure gas flow.

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Journal Club May 2017 - Suicide Risk Assessment

Journal Club May 2017 - Suicide Risk Assessment

Emergency physicians regularly see psychiatric patients who are having suicidal thoughts or engage in non-suicidal self-injurious (NSSI) behavior. In addition to working these patients up medically, it is part of our job to determine who needs emergent evaluation by a psychiatric provider and who is safe for discharge. This is a very important decision, as we do not want to send high risk patients home and keep low risk patients for extended periods of time while they await their evaluation. Balancing this can be difficult - oftentimes it is not obvious where a patient falls on this spectrum. We are taught various decision aids in medical school to help us risk stratify these patients - but how do they perform on emergency department patients? For this month's journal club, we looked at three papers that examine three different decision aids to help elucidate this issue.

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Bud's Common and Simples - Avulsed Teeth

Bud's Common and Simples - Avulsed Teeth

Dr. George "Bud" Higgins shares with us some tricks of the trade regarding evaluating and reimplanting avulsed teeth.  He answers four key clinical questions for us: 1) How do you classify dental injuries?  2)  How do you know whether or not the avulsed tooth is a primary tooth?  3) When should you consider reimplanting avulsed teeth? 4) How do you reimplant and stabilize an avulsed tooth until the patient can follow up with a dentist? 

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ACEP CLINICAL POLICY - CRITICAL ISSUES IN THE EVALUATION AND MANAGEMENT OF ADULT PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE HEADACHE

ACEP CLINICAL POLICY - CRITICAL ISSUES IN THE EVALUATION AND MANAGEMENT OF ADULT PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE HEADACHE

While clinical policy does not necessarily establish a standard of care, it is important to know where your organization stands on key clinical questions.  This American College of Emergency Physicians clinical policy summary focuses on the evaluation and management of adult patients presenting to the emergency department with acute, nontraumatic headache.  It focuses on five critical questions: (1) Does a response to therapy predict the etiology of an acute headache? (2) Which patients with headache require neuroimaging in the Emergency Department? (3) Does lumbar puncture need to be routinely performed on ED patients being worked up for nontraumatic subarachnoid hemorrhage whose noncontrast brain computed tomography (CT) scans are interpreted as normal? (4) In which adult patients with a complaint of headache can a lumbar puncture be safely performed without a neuroimaging study? (5) Is there a need for further emergent diagnostic imaging in the patient with sudden-onset, severe headache who has negative findings in both CT and lumbar puncture? 

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Can I Really Send that PE home?

Can I Really Send that PE home?

With the advancement of CT imaging, emergency physicians are diagnosing a wider spectrum of pulmonary embolism in the emergency department - from the "saddle embolus" to the small subsegmental filling defect.  With this spectrum of radiologic diagnoses also comes a spectrum of clinical severity.  Are there any patients with PE that are safe for discharge?  Dr. Ali Raja (voted this year's best speaker at the 2017 Maine Medical Center Winter symposium) helps to clarify this clinical question. 

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Bud's Common and Simples - Fingernail Avulsion Repair

Bud's Common and Simples - Fingernail Avulsion Repair

Fingernail avulsions constitute a unique fingertip injury as they have the potential to result in long term nail deformity and impaired function if not repaired properly.  In order to treat these injuries effectively, the treating provider must understand the anatomy of the nail bed, nail root, and the intricacies of nail growth. In this brief video, Dr. George "Bud" Higgins shares with us how to assess and treat this injury to optimize our patient's chances for successful nail regrowth, function and cosmesis.

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A New Era of Opioid Prescribing in Maine

A New Era of Opioid Prescribing in Maine

Opioid overdose deaths have continued to climb over the past few years. This national trend is also being seen in Maine where it ranked #13 in terms of overdose deaths per 100,000 population (MMWR: Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015). In response to this trend, Maine has recently passed legislation controlling the prescription of opioids and benzodiazepines.  Here are are six provisions of the new law every prescribing physician should know. 

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