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ECU EM
Official twitter of the East Carolina University Emergency Medicine Residency Program.
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ECU EM Sep 7
Our traditional 14ga angiocaths lack the length for 2nd intercostal space mid-clavicular approach in our american fat patients
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ECU EM Sep 7
Needle decompression of tension ptx has 40% failure rate.
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ECU EM Sep 7
Very small data showing better pain without complications for using pigtails over traditional chest tubes in trauma
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ECU EM Sep 7
Good data that small tubes work just as well as large ones for traumatic pneumo/hemothorax.
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ECU EM Sep 7
Data isn’t great on occult pneumothoracies going under positive pressure. Can be managed without chest tube, but need careful obs.
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ECU EM Sep 7
CXR nl but CT shows PTX? It’s occult, and admission to trauma for observation is the best practice.
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ECU EM Sep 7
We’re EM docs. We should read all our own studies. Every time. Especially if we’re concerned. Even CTs.
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ECU EM Sep 7
Across all settings miss rates of radiologists are 3-5%. In the ED alone it’s closer to 10%. Help them by giving clinical info!
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ECU EM Sep 7
Guidelines from yale say no need for pretreatment for reactions to fish/peanuts/etc when giving IV contrast.
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ECU EM Sep 7
Contrast reaction can be severe but it’s usually anaphylactoid - not IgE mediated and can occur on first dose.
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ECU EM Sep 7
IV contrast does produce some weird feelings in people like the sensation of urination, malaise, and cough. It’s not allergy.
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ECU EM Sep 7
Shellfish allergy is not an iodine allergy. Its other proteins and stuff that’s responsible.
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ECU EM Sep 7
Another myth: Iodine allergy. Seriously. It doesn’t exist. Not compatible with life.
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ECU EM Sep 7
CT scan sensitivity for ovarian torsion just as good if not better than ultrasound.
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ECU EM Sep 7
Normal size ovaries with blood flow on doppler and a somewhat reassuring history is pretty reliable for excluding torsion.
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ECU EM Sep 7
Intermittent ovarian torsion much more common than intermittent testicular torsion.
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ECU EM Sep 7
Ultrasound also cannot rule out ovarian torsion. torsion-detorsion common. 66% sensitive.
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ECU EM Sep 7
Color doppler is only 76% sensitive for torsion in the testicle.
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ECU EM Sep 7
40% of people with true torsion have intact creamasteric reflex.
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ECU EM Sep 7
Both doppler ultrasound and H&P are lousy at ruling out testicular torsion. Wonderful.
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