Anterior Drawer Test Assesses: Anterior talofibular ligament (ATFL) Position: Knee joint in flexion and ankle in 10-15 degrees plantar flexion Maneuver: The examiner exerts a downward force on the tibia while simultaneously attempting to “lift up” the foot while grasping behind the heel. Interpretation: A significant difference from the unaffected…
Category: Emergency Medicine
The Real Emergency Room scenarios, cases and topic reviews. Medical emergency conditions – approach to diagnosis and management.
Emergency Medicine 
Ottawa Foot, Ankle and Knee rules – Mnemonic
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…
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…
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…
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…
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…
Emergency Medicine 
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…
Emergency Medicine 
Acute STEMI Management – Mnemonic based approach
60 year old smoker patient came with epigastric pain and shortness of breath for 4 hours. The patient was tachypneic with SpO2 90%. Other vital signs were relatively stable. ECG was done, Troponin I was positive and CK-MB was 100 IU/l. What is there in ECG above? ST elevation and…