Emergency Reversal of Anticoagulation

Owing to the propensity of anticoagulated patients to bleed, a strategy for reversal of anticoagulation induced by any of the common agents is essential. Many patients are anticoagulated with a variety of agents, including warfarin, low molecular weight heparin, and the direct oral anticoagulants such as factor Xa and factor IIa inhibitors. Patients may also be using antiplatelet agents. Recommendations to reverse bleeding in these patients are constantly evolving with the recent development of specific reversal agents. A working knowledge of hemostasis and the reversal of anticoagulation and antiplatelet drugs is required for every emergency department provider. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient

Cranial Neuropathies and Neuromuscular Weakness: A Case of Mistaken Identity

We describe a case of wound botulism initially thought to represent Miller-Fisher variant Guillain-Barré syndrome (MFS). Botulism classically presents with the so-called “four D’s” (diplopia,dysarthria, dysphagia, dry mouth) with symmetric, descending weakness. MFS presents with a triadof limb-ataxia, areflexia, and ophthalmoplegia, with variable cranial nerve and extremity involvement.The distinction can be difficult but is important as early initiation of botulinum antitoxin is associatedwith improved patient outcomes in cases of botulism. Furthermore, it is important to recognizeintravenous drug use as a risk factor in the development of botulism, especially given an increase ininjection drug use

Cranial Neuropathies and Neuromuscular Weakness: A Case of Mistaken Identity

We describe a case of wound botulism initially thought to represent Miller-Fisher variant Guillain-Barré syndrome (MFS). Botulism classically presents with the so-called “four D’s” (diplopia,dysarthria, dysphagia, dry mouth) with symmetric, descending weakness. MFS presents with a triadof limb-ataxia, areflexia, and ophthalmoplegia, with variable cranial nerve and extremity involvement.The distinction can be difficult but is important as early initiation of botulinum antitoxin is associatedwith improved patient outcomes in cases of botulism. Furthermore, it is important to recognizeintravenous drug use as a risk factor in the development of botulism, especially given an increase ininjection drug use

Cranial Neuropathies and Neuromuscular Weakness: A Case of Mistaken Identity

We describe a case of wound botulism initially thought to represent Miller-Fisher variant Guillain-Barré syndrome (MFS). Botulism classically presents with the so-called “four D’s” (diplopia, dysarthria, dysphagia, dry mouth) with symmetric, descending weakness. MFS presents with a triad of limb-ataxia, areflexia, and ophthalmoplegia, with variable cranial nerve and extremity involvement. The distinction can be difficult but is important as early initiation of botulinum antitoxin is associated with improved patient outcomes in cases of botulism. Furthermore, it is important to recognize intravenous drug use as a risk factor in the development of botulism, especially given an increase in injection drug use

A Formalized Three-Year Emergency Medicine Residency Musculoskeletal Emergencies Curriculum

Audience and type of curriculum: The Ohio State University Emergency Medicine Residency Program Musculoskeletal Emergencies Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Musculoskeletal complaints/injuries compose a significant proportion of emergency department visits; in fact, many can result in significant morbidity. These conditions present in a vast array of acuities from minor to life/limb threatening. Emergency medicine physicians must be facile in diagnosing and managing various musculoskeletal conditions. We aim to present a three-year curriculum that incorporates clinical experience, self-directed learning, and small group-based didactics using the flipped classroom model to allow learners to master the diagnosis and management of musculoskeletal emergencies. This curriculum will provide progressive training in the diagnosis and management of musculoskeletal emergencies. Objectives: Resident learners will master the diagnosis and management of emergent musculoskeletal conditions including fractures/dislocations, soft tissue injuries, compartment syndrome, joint complaints, infections, and complex injuries. Methods: The educational strategies used in this curriculum include: independent, self-directed learning via textbook and medical literature reading, didactic sessions describing the diagnosis and management of musculoskeletal conditions, a four-week orthopedic surgery rotation, and an optional four-week rotation at a medical center-affiliated sports medicine practice. Residents are expected to actively participate in the care of patients with musculoskeletal conditions/injuries presenting to the emergency department during the course of their residency training. The time requirements, reading material, and diagnosis/management techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has specific objectives and educational material

A Formalized Three-Year Emergency Medicine Residency Musculoskeletal Emergencies Curriculum

Audience and type of curriculum: The Ohio State University Emergency Medicine Residency Program Musculoskeletal Emergencies Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Musculoskeletal complaints/injuries compose a significant proportion of emergency department visits; in fact, many can result in significant morbidity. These conditions present in a vast array of acuities from minor to life/limb threatening. Emergency medicine physicians must be facile in diagnosing and managing various musculoskeletal conditions. We aim to present a three-year curriculum that incorporates clinical experience, self-directed learning, and small group-based didactics using the flipped classroom model to allow learners to master the diagnosis and management of musculoskeletal emergencies. This curriculum will provide progressive training in the diagnosis and management of musculoskeletal emergencies. Objectives: Resident learners will master the diagnosis and management of emergent musculoskeletal conditions including fractures/dislocations, soft tissue injuries, compartment syndrome, joint complaints, infections, and complex injuries. Methods: The educational strategies used in this curriculum include: independent, self-directed learning via textbook and medical literature reading, didactic sessions describing the diagnosis and management of musculoskeletal conditions, a four-week orthopedic surgery rotation, and an optional four-week rotation at a medical center-affiliated sports medicine practice. Residents are expected to actively participate in the care of patients with musculoskeletal conditions/injuries presenting to the emergency department during the course of their residency training. The time requirements, reading material, and diagnosis/management techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has specific objectives and educational material