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…
Author: Epomedicine
Clinical Skills and Approaches
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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
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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
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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
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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
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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
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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…
Emergency Medicine
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Well’s and PERC Criteria for Pulmonary Embolism : Mnemonic
Well’s Criteria (Modified and Simplified) Mnemonic: CHADS (Remember, this is not the CHADS2 score for Atrial Fibrillation) Clinical features of DVT Cancer Heart rate > 100/min Hemoptysis Alternative diagnosis less likely DVT/PE in past Surgery in past 4 weeks or Immobilization for 3 days Well’s criteria Original score Simplified score…