- Concussion in athletes
Essential Evidence Topics, 10-Jul-2021
Overall Bottom Line: Concussion includes a spectrum of manifestations that can range from transient mild symptoms to ongoing disabling problems. Players with previous concussion are more likely to have recurrent concussion. Women and athletes with thr - Cyanide poisoning
Essential Evidence Topics, 7-Apr-2022
Background: Cyanide can cause rapidly fatal poisoning following exposure by the oral, inhalation, and dermal routes. Only acute cyanide poisoning is considered in this chapter. - Digoxin toxicity
Essential Evidence Topics, 17-Jun-2021
Bottom-line: Suspect digoxin toxicity in patients taking digoxin who present with GI symptoms, visual changes, lethargy, confusion, weakness, or characteristic ECG changes (). Initial assessment should include digoxin level, potassium, and ECG. Monitor re - Dislocation (hip)
Essential Evidence Topics, 3-Jan-2021
Overall Bottom Line: If the patient complains of hip pain or presents with a history of significant trauma, obtain plain AP, lateral, and oblique radiographs of the pelvis. Hip dislocations should be reduced as soon as possible to reduce the likelihood - Dislocation (shoulder)
Essential Evidence Topics, 27-Feb-2022
Overall Bottom Line: Prereduction radiographs can be limited to individuals with first-time dislocation, age more than 40 years, and history of trauma. Bankart lesions do not heal conservatively and need to be surgically repaired to decrease the likelih - Diving injury and decompression sickness
Essential Evidence Topics, 8-Jun-2021
Overall Bottom Line: Maximum depth of last dive, complete relief of symptoms after first recompression, fine cerebellar signs as secondary symptoms, history of missed decompression stop in recent dive and previous history of decompression sickness (DCS) w - Domestic and intimate partner violence
Essential Evidence Topics, 17-Apr-2022
Background: Bottom-Line Domestic violence is a common problem that has a direct and indirect impact on the health of victims, perpetrators, and witnesses. Suspect domestic violence in patients presenting with inadequate or irregular history, partner ref - Ethylene glycol poisoning
Essential Evidence Topics, 1-Mar-2021
Overall Bottom Line: Ethylene glycol toxicity should be suspected in patients presenting with altered mental status and possible/unknown substance ingestion. Diagnostic laboratory tests should include arterial blood gases, serum chemistries, anion gap, - Falls in elderly patients
Essential Evidence Topics, 4-Dec-2020
Overall Bottom Line: All older persons should be asked about falls. Patients may not volunteer this information. Patients who have fallen or have a gait or balance problem are at higher risk of future falls. Screen for gait and balance in patients > - Food allergy
Essential Evidence Topics, 27-Jan-2021
Overall Bottom Line: While adverse reactions to food are common in the population, true food allergy represents a small percentage of all adverse reactions. It is important to determine if an IgE-mediated food allergy is present. The primary tools ava - Foreign body (nasal and ear)
Essential Evidence Topics, 21-Jul-2021
Overall Bottom Line: Perform otoscopy or rhinoscopy to confirm diagnosis of ear or nasal foreign body (FB) in a child presenting with unilateral mucopurulent discharge of the ear or nose. Remove external auditory canal FBs using irrigation, suction, or i - Fracture (arm)
Essential Evidence Topics, 11-May-2021
Overall Bottom Line: Take note of history of direct blow to forearm, or a fall on an outstretched hand or directly on forearm. Get anteroposterior, lateral, and oblique x-rays for most suspected fractures. If neurovascular compromise is evident, refer - Fracture (finger and hand trauma)
Essential Evidence Topics, 30-Jan-2022
Overall Bottom Line: All finger and hand trauma require radiographic evaluation with posteroanterior, lateral, and oblique views. Treatment for distal phalanx extensor mechanism disruption (mallet finger) requires continuous splinting in extension for a - Fracture (foot and toes)
Essential Evidence Topics, 17-Mar-2020
Overall Bottom Line: Always include evaluation and documentation of distal neurovascular status in the physical examination. Use Ottawa Foot Rules, to determine the need for foot films. If x-ray is warranted, obtain three-view foot series and/or dedic - Fracture (leg)
Essential Evidence Topics, 23-Apr-2022
Overall Bottom Line: Use Ottawa Knee Rules to decide whether radiographs are needed for knee injury. For all other parts of the leg consider radiographic imaging if there is significant bony tenderness, deformity on exam, and/or a concerning history for - Fracture (rib)
Essential Evidence Topics, 20-Oct-2021
Overall Bottom Line: Order standard PA and lateral CXRs if rib fracture is suspected; order a skeletal survey for any child with rib fractures suspected to have been abused. Order a bone scan if radiographs are normal and the level of suspicion of rib f - Fracture (vertebral compression)
Essential Evidence Topics, 20-Jul-2021
Overall Bottom Line: Plain X-rays are recommended for acute back pain in patients older than 50 years, those with pain for longer than 1 month, or those with a history of malignancy, corticosteroid use, unexplained weight loss, or previous vertebral compr - Fracture (wrist in adults)
Essential Evidence Topics, 28-Feb-2022
Overall Bottom Line: The mechanism of injury and the area of the wrist that is painful, discolored, swollen, deformed, or tender correlate well with the specific bones of the wrist that have been fractured. In a patient with wrist trauma, initial imagin - Fracture (wrist in child)
Essential Evidence Topics, 28-Jan-2022
Overall Bottom Line: The Amsterdam Pediatric Wrist Rule can be used to determine if further evaluation for a wrist fracture is indicated. The majority of wrist fractures are treated conservatively, with closed reduction and casting or splinting. The pro - Hallucinogen poisoning
Essential Evidence Topics, 2-Nov-2021
Bottom-line: Address the ABCs (airway, breathing, circulation). Do not give ipecac or activated charcoal without recommendation from a poison center or emergency department. Acute intoxication is managed by minimizing stimulation and “talk down therapy”
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