Category Archives: Emergency Medicine

Ataxia: The Physical Examination

Ataxia is an extremely important clinical sign that has a broad and important differential diagnosis. Causes of ataxia include posterior circulation strokes and various toxic and metabolic insults to the cerebellum (and sometimes to the spinocerebellar tracts). Ataxia can be a very subtle physical finding, especially when you don’t know what to look for or when you are… Read More »

Central vs. Peripheral Vertigo Simplified

The first and most important step in evaluating a patient with vertigo is to attempt to distinguish vertigo of central origin from vertigo of peripheral origin because the management of central vertigo (brain imaging, hospital admission) is very different from the management of peripheral vertigo (symptomatic treatment, outpatient referral). Differences Between Central and Peripheral Vertigo Peripheral Vertigo Central Vertigo Percentage… Read More »

Stroke & TIA Mimics

Here are the important stroke and TIA mimics: Systemic and metabolic insults: especially hypoglycemia, but also a very wide variety of other systemic insults such as infections (urinary tract infections, pneumonia) and toxins, all of which can cause re-expression of symptoms of old strokes. Peripheral neuropathies such as idiopathic seventh cranial nerve (Bell’s) palsy, peripheral vestibulopathy, and even… Read More »

Headache: The Ominous Causes

Introduction Most headaches are benign and do not require a specific workup. Here are the ominous ones that require a specific workup and management. From the Patient History Sudden, severe, and maximal at onset, especially in an older patient without a prior history of headaches → subarachnoid hemorrhage → get a head CT without contrast → CT angiogram or cerebral angiogram. Systemic… Read More »

How to Remember the Causes of Arrhythmias (the H’s and T’s)

Causes of arrhythmias, including asystole, include: H‘s: think about what blood does: Volume (hypovolemia) Oxygen (hypoxemia) Glucose (hypoglycemia) Potassium (hypo- or hyperkalemia) Acid-base balance (H+ or acidosis) Temperature regulation (hypothermia) T‘s : imagine a (toxic) lead bullet piercing a chest. What can it cause? Trauma Toxins Tamponade Tension pneumothorax Thrombosis (PE or MI) Reference Dr. Christopher Gallagher’s YouTube video

Atopic Dermatitis (“Eczema”): How to Control it

Step 1: First of all, make sure it’s really atopic dermatitis! Atopic dermatitis is a pruritic, immune-mediated skin condition that is common in all age groups, but is particularly common among infants, toddlers and small children. It is commonly called eczema by clinicians and laypersons alike. There are three different highly pruritic skin conditions that you absolutely need… Read More »