Revision Resources

April 24 FOAMed

Red Rash on My Legs

A 23-year-old female with no known past medical history presented with a rash concentrated on her legs, with a few areas on her arms and chest. The rash began the day before presentation when she became overheated while wearing sweatpants in 104°F weather. The rash was mildly pruritic but not painful. She denied any prior reaction to her sweatpants that she has had for several months. She denied any new soap or cosmetic use, prior rash, allergy, or medication use. Her review of systems and past medical history were negative.

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Thoracic and Lumbar Spine Trauma

A 70-year-old female with a past medical history of osteoporosis, atrial fibrillation, and hypertension presents with acute thoraco-lumbar back pain after a ground-level fall. She was walking her dog who pulled her backwards, landing on her buttocks on the pavement. She denies any loss of consciousness, shortness of breath, chest pain, abdominal pain and denies any motor or sensory weakness.

Her vital signs are blood pressure 144/86, heart rate 88, SPO2 99%, temperature 36.8C, and a glucose of 138. Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back.  She has full motor strength and sensory function in the lower extremities. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence.

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First 48 Hours of PE Management

The mainstay of treatment for symptomatic pulmonary embolism  (PE) is anticoagulation (AC).  Patients with higher-risk PE may require advanced interventions such as thrombolytic therapy, surgical thrombectomy, or even extracorporeal membrane oxygenation (ECMO). Because of its short half-life and availability of a reversal agent, unfractionated heparin (UFH) is commonly used when percutaneous or surgical interventions are being considered.

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