Ottawa Ankle and Foot Rules Mnemonic: 44-55-66-PM Patients need an X-ray only if: 4: Unable to do 4 steps immediately AND4: Unable to do 4 steps at Emergency Department OR 5: Has pain at the base of 5th metatarsal5: Has pain at the 5caphoid (Navicular) OR 6: Tenderness in 6…
Author: Epomedicine
Emergency Medicine 
San Francisco Syncope Rule (FED 30 90)
San Francisco Syncope Rule (SFSR) defines high risk criteria for patients with syncope. FED 30 90 Failure (Congestive heart failure) ECG abnormalities Dyspnea (shortness of breath) Hematocrit <30% Systolic blood pressure <90 mmHg (at any time) Presence of any of the above criteria is regarded as positive. Mnemonic: CHESS Congestive…
Clinical Skills and Approaches 
Hot Potato Voice
Synonyms: Hot potato speech, Potato in mouth It is a term for a defect of resonance in which the speech has muffled quality, fancifully likened to a person speaking with a (very) hot potato in their mouth. Mechanism of Hot Potato Voice: Hot potato voice is the result of an…
Emergency Medicine 
Manual detorsion of testis in Testicular Torsion
Indications of Manual Detorsion It can serve as a temporizing measure to attempt to reperfuse the testis while the patient is awaiting definite surgical management. Contraindications of Manual Detorsion Manual detorsion is not recommended for torsion of duration >6-8 hours (prolonged ischemia leads to marked swelling and edema after which…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Wilm’s Tumor (Nephroblastoma) : Quick review
Wilm’s tumor is the most common primary renal tumor of childhood. Origin: Embryonic nephrogenic (mesodermal) cells Mechanism: Deletion of WT-1 gene on chromosome 11 Pathology: a. Macroscopic (Gross): large, solitary tan to grey color mass; pale on cut section with areas of hemorrhage; 10% are bilateral or multicentric; grossly difficult…
Emergency Medicine 
C-spine Clearance
C-spine clearance refers to a clinical decision suggesting the absence of acute bone related, ligamentous and neurologic abnormalities of the cervical spine based on history, physical exam and/or negative radiologic studies. NEXUS criteria for C-spine Clearance NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Dizziness : History and Examination
HISTORY Mnemonic: 4D-3E-2Fg-2H 1. Define “Dizziness”: Room is spinning/rocking/somersaulting – Vertigo Feel like “going to faint” – Near-syncope “Going to fall” or “Unsteady on feet” – Disequilibrium Feel like they’ve or are “left their body” or “floating/swimming” – Psychophysiologic dizziness 2. Duration of each episode: Seconds: BPPV Minutes: TIA or…
Emergency Medicine 
Pulmonary Embolism : Chest X-ray Signs
1. Classic presentation is normal X-ray in patient with dyspnea and hypoxia 2. Atelectasis or parenchymal abnormality (68%) 3. Elevated hemidiaphragm 4. Pleural effusion (Felson’s sign – pleural effusion on left > right) 5. Hampton’s hump: peripheral pleural based wedge-shaped density above the diaphragm due to pulmonary infarct 6. Westermark’s…