June 22, 2020

Ear, nose, and throat (ENT) complaints are commonly seen in the emergency department. When you hear “ENT emergencies,” you probably think about epistaxis, sinusitis, and possibly foreign body removal (either from the ear or nose). While not as common, auricular hematomas are equally important to both understand and know how to manage. As a former wrestler, I can attest to the importance of 1) knowing how to accurately diagnose and 2) how to treat this injury to prevent future development of “cauliflower ear”. An auricular hematoma is a collection of blood underneath the perichondrium of the ear that typically occurs secondary to trauma. Common mechanisms of injury include an ear-piercing gone wrong or blunt trauma in contact sports (wrestling, boxing, and martial arts). Inadequate treatment of an auricular hematoma can lead to the development of an auricular deformity commonly known as “cauliflower ear,” which develops from permanent cartilage destruction.

May 27, 2020

Take Home Points
  • Small to Moderate Size Pneumothorax - consider managing conservatively with observation (need to make sure consulting services on same page)
  • Needle aspiration for spontaneous pneumothorax recommend by British Thoracic and European Respiratory Societies
  • 1 in 5 patients requiring a chest tube will suffer complications - many are iatrogenic in nature. Practice procedure via simulation 
  • Chest tubes placed for traumatic pneumothoraces should get prophylactic antibiotics
  • When deciding on treatment strategy, discuss with your consultants and make sure you have institutional buy-in.

April 22, 2020

Take Home Points
  • N95 masks ideally should be single use but in COVID19 times, safe reuse practices are critical.
  • The best approach to reuse is vaporized H2O2 and UV light decontamination with a total of 3 decon cycles prior to losing mask integrity.
  • A backup method of cycling between 4 masks is likely effective as SARS-CoV-2 cannot survive > 72 hours outside a human host in sufficient numbers to cause infection.
  • Ethanol soaks are effective in decontamination but destroy mask integrity and should not be use.

April 8, 2020

Take Home Points
  1. Hyperthyroidism can present along a spectrum from the minimally symptomatic to severely decompensated and presentation can vary with age
  2. If there are a lot of interconnecting systems complaints consider obtaibning a TSH, t3 and t4 
  3. Once you’ve diagnosed hyperthyroidism, dont anchor on it. Look for what might have caused it especially in those with comorbidities
  4. If the patient is stable and reliable you can discharge them home with Atenolol. Make sure to have the patient follow up with their PCP or Endocrinologist. If, however, you feel uncomfortable doing that or the patient needs more social support, call your endocrinologist on call and get their recommendations.