• Emergency Medicine Physical Diagnosis

    Emergency Medicine Physical Diagnosis

Emphysicaldiagnosis.com changing to Tothebedside.com

Hello, I am changing the name of my site to “tothebedside.com” All of the posts have been ported over. Thank you for visiting and please save the new page if you are a regular visitor. James Nelson MD

DENGUE FEVER: SIGNS OF CAPILLARY FRAGILITY

A patient presents with a rash and fever after recent travel to Bolivia. She was there for one week and returned 3 days ago. She took her antimalarial medication, so could this be dengue fever? Fever in the returning traveler relies on Bayesian thinking. We start with probabilities based on endemic diseases and then the … Continue reading

INTACT CREMASTERIC REFLEX DOES NOT RULE OUT SPERMATIC CORD TORSION

A patient presents with acute testicular pain. You were concerned about spermatic cord (testicular) torsion but find an intact cremasteric reflex. Do you send the patient home? In 1984 Rabinowitz introduced the cremasteric reflex as diagnostic of spermatic cord torsion. Stroking the inner thigh near the testicle produces ipsilateral contraction of the cremasteric muscle, with … Continue reading

LISFRANC JOINT INJURIES: PALPATE AND TWIST

We think of the foot as a simple thing but it actually comprises one fourth of all the bones of the body, with 26 overall. Although some stability comes from the arch structure (the Roman arches did not require mortar) most of the stability of the foot is ligamentous. It therefore should not be surprising … Continue reading

PHYSICAL DIAGNOSIS OF OCCULT HIP FRACTURES

An elderly female presents after a fall. You were concerned about hip fracture but the x-rays were negative. You go back to examine her and she is able bear weight but she has a very slow and antalgic gait. You order a CT scan of the hip and this also comes back normal. You go … Continue reading

LUMBAR SPINE NEUROLOGICAL EXAMINATION TEMPLATE

The neurological examination is relative to the pathology you are investigating. This should not be used in a cut and paste fashion but rather for reference.   MOTOR Hip flexion “pull your knee to your chest” (L2/3) 5/5 Hip adduction “pull your knees into each other” (L2/3) 5/5 Hip abduction “pull your knees apart” (L4/5/S1) … Continue reading

TWIST AND SHOUT – DIAGNOSING OCCULT TODDLER’S FRACTURE

A 2 year old presents with leg pain and a limp after slipping on a “slip and slide” water toy slide. X-rays are negative. The child will step when asked but will not walk on his own. Is this an occult fracture? This is a situation where the reference standard, radiography, has limitations in sensitivity. … Continue reading

CAPACITY TO REFUSE CARE: DO THEY UNDERSTAND THE PAST, PRESENT, AND FUTURE?

A patient presents brought for medical clearance prior to transport to the county psychiatric facility. She is on a 5150 for being a threat to others. The patient states that she refuses the required screening tests. What do you do? If she has the capacity to make decisions then she can indeed refuse care. Being … Continue reading

PALPATE JUGULAR VENOUS DISTENSION

An obese patient presents with edema. You look for jugular venous distension and wonder if you see the ebbing in the neck (“Y descent”). Before you order BNP, there is one more thing you can do. Palpate the vein. Large veins are palpable. In the days before we used ultrasound for central lines many of … Continue reading

RECOGNIZE APNEA RISK FOR BRONCHIOLITIS IN THE FIRST 2 MONTHS OF LIFE

A 5 week old presents with nasal congestion and difficulty breathing. RSV bronchiolitis is ultimately diagnosed. Can the patient go home? Not every infant with bronchiolitis can be admitted. But the ED provider must be aware that the dreaded complication of apnea tends to occur in patients who are under 2-3 months old. The studies … Continue reading

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