• Emergency Medicine Physical Diagnosis

    Emergency Medicine Physical Diagnosis

MANUAL REDUCTION OF SPERMATIC CORD (TESTICULAR) TORSION

A patient presents with right-sided testicular pain and swelling for 1 hour, associated with nausea and vomiting. Physical examination shows tenderness and swelling in both the epididymis and testicle itself. The epididymis is anterior to the testicle, and palpation of the spermatic cord reveals a 1cm nodule about 2 cm above the testicle. You call … Continue reading

SPERMATIC CORD TORSION (TESTICULAR TORSION): PALPATE THE CORD

Most people use the term “testicular torsion,” but throughout history it has also been called “spermatic cord torsion.” Many urologists prefer this term. One introduced it as “acute spermatic cord torsion, more commonly and not so exactly named testicular torsion (TT)…”(Drlik M. J Ped Urol 2013) The reason spermatic cord torsion is a better term … Continue reading

THE PEDIATRIC EXAMINATION PART 3: LOCALIZATION BY PROXY

In the last 2 posts we discussed techniques for winning rapport and trust with children and for using distraction and play. We discussed a case of a 16 month old with scalp tenderness. In that case none of these techniques worked. So what do you do next? Parent’s Arms Most children between the ages of … Continue reading

THE PEDIATRIC EXAMINATION PART 2: DISTRACTION AND PLAY

In the previous post we talked about using proper greetings and explanation to win rapport and trust. We talked about a 16 month old with scalp pain that could not be localized. Often efforts at rapport and trust do not work. What do you do next? For straightforward presentations there is nothing wrong with physical … Continue reading

THE PEDIATRIC EXAMINATION PART 1: RESPECT AND EXPLANATION

A 16 month old presented with pain in the scalp. The examiner was not able to localize it further because the child was uncooperative and crying. What now? To localize pain in a toddler, we need the child’s cooperation. There are three ways to achieve this. The first approach is to win rapport and trust. … Continue reading

DELIRIUM: COUNTING MONTHS BACKWARD

An elderly patient is brought by family for confusion. You wonder whether this is delirium, or whether dementia may have developed. As covered in a previous post, dementia is defined by a deficit in memory as well as one other cognitive function. You can easily test for 3 item recall and clock drawing. But for … Continue reading

IDENTIFYING AND ADDRESSING PATIENT CONCERNS: AGENDA SETTING

It is possible to adequately address a chief complaint but not identify or meet the patient’s concerns. Agenda setting is defined as that process of the medical encounter where the doctor and patient agree on the plan for the visit. If agenda setting is not done, it defaults to whatever the doctor thinks is needed, … Continue reading

CELLULITIS: DON’T JUST LOOK – FEEL!

  Cellulitis, when you think about it, is probably not the most helpful term. Literally, it means “infection of cells.” What cells? The anatomical area is actually the dermis, as well as the subcutaneous tissue.   A patient presenting with “dermitis” has a lesion that is clearly confined to the skin. A patient presenting with … Continue reading

ORBITAL COMPARTMENT SYNDROME: CHECK FOR AFFERENT PUPILLARY DEFECT

A patient presents in a coma after head and face injury. You note proptosis and the CT shows retroorbital hematoma. You wonder whether you should decompress this. Normally we based decompression on visual acuity but that is not available in the comatose patient. What can we do?   Afferent pupillary defect (swinging flashlight test) may … Continue reading

BEDSIDE DIAGNOSIS OF COAGULOPATHY

A patient presents found in the rural backcountry after a motor vehicle accident. She has a grade V liver laceration and is not stable for transfer. Your general surgeon is getting ready to take her to the operating room for damage control laparatomy and packing. You notice she is oozing from her central line site. … Continue reading

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