Lidocaine Patch

Lidocaine Patch

We hope to identify the effects of adjunctive 5% lidocaine patches in the treatment of acute non-radicular low back pain in patients discharged from the emergency department.

We hypothesize that in patients with acute non-radicular low back pain (LBP), treatment with adjunctive lidocaine 5% transdermal patches will lead to improved pain at one week compared with standard therapy alone.

Using a prospective randomized controlled study design, we will compare the addition of lidocaine 5% patches to standard therapy vs standard therapy alone in the relief of pain for patients discharged from the emergency department (ED) with acute non-radicular LBP.

HEART Score

HEART Score

Chest pain is a very common cause of complaint in the Emergency Room. The diagnosis of  non-ST-elecation acute coronary syndrome often causes uncertainty in physicians thus the HEART Score we developed to help with risk stratification. HEART is an acronym for History, ECG, Age, Risk factors and Troponin. The goal of our study is to determine if the HEART score is actually effective on admission rates and if it’s helping to save cost.

Clinical Pearl #1 (10/13): Fracture of the clavicle bone vs protrusion of the clavicle bone-Differences and Treatment Options?

Clinical Pearl #1 (10/13): Fracture of the clavicle bone vs protrusion of the clavicle bone-Differences and Treatment Options?

Patient had fallen down on his side two days  ago;  he came to the ER this morning and complained of shoulder pain. Patient was asked to remove his t-shirt. The doctor took a quick glance and checked for symmetry. The left and right side (frontal view) of the patient’s did not look symmetrical.  The left side of the patient’s shoulder region was swollen and there was slight redness (the redness, however, was not a cause of concern). The patient was asked to take his left arm and touch his right shoulder. The patent groaned ,due to the pain, as he tried to touch his right shoulder. However, the patient was able to complete the task. This was a sign that the clavicle (shoulder bone ) was not dislocated. If a dislocation had occurred, the patient would not have been able to reach for the other side of his body at all. The patient had initially thought that he had a protrusion of the clavicle bone (one would have seen something like a bump or “tent” deformity) but this was not the case. The patient was asked for any other important information. The patient was diabetic and had blood sugar of about 370. The patient had stopped taking his diabetic medications almost a year ago. The doctor prescribed appropriate medication to treat the high level  of blood sugar. The best treatment option for the patient was to use a sling for about 6-8 weeks. Popping the bone back into position would not have been possible in this case, because even  if the bone were to be popped back, the bone would pop back out due to the muscle that was pulling on the clavicle bone. Surgery was definitely not an option, because the surgery would not have provided any extra benefit. Even being in the sling for the appropriate amount of time  would allow the patient to have full-range motion. If the patient had the clavicle bone protruding through the skin,  the patient would have needed to undergo surgery to fix  the issue; pushing the bone back in would not work in this case. If something like this is left for too long,  the bone can protrude through the skin and can lead to an open wound infection. A fracture of this kind in the clavicle bone wouldn’t allow for full-range motion; however, something like protrusion of the clavicle bone may still allow the patient to have full-range of motion, but this situation is more of a concern as it may lead to an open wound infection.

COPD / CHF

COPD, chronic obstructive pulmonary disorder, and CHF, congestive heart failure, both have similar symptoms and risk factors. When a physician takes the vitals of the patient, the heart rate, respiratory rate, and blood pressure all may correlate to COPD, CHF, or even both sometimes. When looking at what the disorders actually impact makes them very different however. COPD generally affects the lungs, while CHF is a disorder from the heart. Smoking for example is a risk factor for both COPD and CHF. Smoking increases the risk of bronchitis and emphysema, the two conditions of COPD. Smoking may also increase the risk of heart failure and heart disease.

The entitled CO2 machine can better differentiate the breathing rates of these patients, while seeing whether the diagnoses of the patient is either COPD, CHF, or both. It allows us to see the rate of carbon dioxide being let out during exhalation of the patient.

Seminar 20. Scholarship Assessment

20. Scholarship Assessment

Exercises

Choose two activities listed on your CV.  Evaluate those activities using the 6 scholarship assessment standards of Boyer and Glassick.

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Readings

– Glassick C. Boyer’s expanded definitions of scholarship, the standards of assessing scholarship, and the elusiveness of the scholarship of teaching. Acad Med 2000;75:877-80.

“This is an exciting time for those interested in a scholarly world and its measurement.”

Charles Glassick