Author: Alyssa Cocchiara, DO

Sunday Scaries

Gout: Don’t Poo Poo Podagra

Gout: Don't Poo Poo Podagra We spend a lot of time talking about septic joints/arthritis, when/when not to do the joint aspirations, but how about our forgotten mono-arthritic friend GOUT.  Picture yourself on an overnight shift, it's 5:30a and on your board pops up a 50yr Male with Foot Pain. You walk over to the bed and see this foot "Greaaaatttt" you think to yourself, "does this person want a work note? Are they seeking opiates? Do I attempt to do an arthrocentesis? How is this an EM problem?!?!" WHO?: 1-4% of overall population. Think: Old Obese

by Alyssa Cocchiara, DO
Sunday Scaries

The ‘Dislodged’ PEG Tube – Sunday Scary

The "Dislodged" PEG Tube This is a CLASSIC Coney patient. 83yr old nursing home patient arrives with chief complaint of "dislodge peg tube" or "peg tube needs replacement", completely contracted and luckily the nursing home staff was nice enough to send the chewed up old tube in a chuck with the patient.-->What do you do next? What if this tube has been out for an extended period of time? What if the tube is still in the patient but they are requesting a change? Step 1: Determine the time frame the tube was placed AND how long the tube has been dislodged A

by Alyssa Cocchiara, DO
Sunday Scaries

Tetanus – Sunday Scary

The Importance of the Tetanus Vaccination In case you've missed this little gem last month: Summary: unvaccinated 6 yr old Oregon boy sustained lac to the forehead and his hipster parent cleaned and sutured the lac at home. Boy got tetanus (surprise, surprise) and spent several weeks in the PICU fighting for his life. After a million dollars of medical care, parents again refused to give tetanus vaccination Tetanus Schedule Reminder: DTap and Tdap have coverage for diptheria, pertussis and tetanusTd (recommended in adults >65yrs not in contact with y

by Alyssa Cocchiara, DO
Sunday Scaries

What’s the Deal with UTIs – Sunday Scary

Urinary Tract Infection The Case: 60-something year old male presents to the ED with signs of urinary frequency and feelings of incomplete voiding. When you see the UA results there are moderate nitrites, moderate leukocyte esterases but NO urine bacteria. Your attending turns to you and says "Why did you order rocephin for sterile pyuria, there are no bacteria", and you turn to your attending to say "because I should have finished this Sunday scary weeks ago. i loathe weird UAs" The UTI Breakdown Upper and Lower Urinary Tract Upper = Kidneys and Ureter (P

by Alyssa Cocchiara, DO
Sunday Scaries

Anterior Hip Dislocation (Sunday Scary)

The Case: 71 yr old female (on Coumadin) presents to the ED after a slip and fall. Pt is laying on the stretcher complaining of left hip pain. What you see when you walk up to the bed is the patient laying like this: Patient had distal pedal pulses, sensation and movement intact and with make shift measurement, it looked as though the malleoli were lined up (no real length discrepancy) After addressing that this little lady was not bleeding in her head, she received x-rays of her left extremity and pelvis: ANTERIOR HIP DISLOCATION IN A NATIVE HIP The Hi

by Alyssa Cocchiara, DO
Sunday Scaries

Urine-time – Sunday Scary

What do you really know about the Urine Analysis? Daily Questions on Shift: This UA shows negative nitrites, negative leuks but TNTC bacteria. "WHAT?!" UA shows multiple epithelial cells. "okay this patient didn't listen to my request for a clean catch". (or my recent favorite) my inbox: urine culture shows "why the hell did i order a culture and now i'm the only one to respond to this!?!?" Urine has been really pissing me off lately. Things we might have forgotten about Urine: -Bedside Analysis: Color, Transparency, Odor, DipstickColor: As much as kno

by Alyssa Cocchiara, DO
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The Blakemore/Minnesota Tube – Sunday Scary

Controlling the Upper GI Bleed...DROP THE TUBE! The Case: 40-something yr old female, known alcoholic with history of esophageal varices presents to the ED with upper GI bleed. Pt is unstable and you gain control of the airway, place a left femoral cordis and start MTP with the rapid infuser. While GI, Surgery, ICU are all at bedside debating what to do, you make numerous suggestions to place a Blakemore (or in our beloved Coney ED a Minnesota) with everyone looking at you in bewilderment on how to place one. Indications to place the tube: -The unstable pa

by Alyssa Cocchiara, DO
Sunday Scaries

Concussion – Part 2 (Sunday Scary)

Last week, I reviewed diagnosis of a concussion and management as well as patient education. And like always, when you read it, you then have a few patients that week with that diagnosis What i wanted to continue with this week is the importance of educating our patients on the SECOND injury. This is the patient that doesn't listen to your brain rest and physical activity restrictions, goes out and gets hit on the noggin a second time. Second Impact Syndrome Rare and potentially fatal complication that involves diffuse cerebral edema secondary to a recurrent or

by Alyssa Cocchiara, DO
Sunday Scaries

Wernicke’s Encephalopathy – Sunday Scary

THE CASE: One of our not so regular alcoholic with pmhx of DM presented to the ED with eye pain with concerns for acute angle glaucoma. Upon discharge up to the eye clinic the patient states he was unable to walk. Muscle strength 5/5 and good reflexes.What was going on here?? Was this man faking it to get an admission or was there something else going on?? WERNICKE'S ENCEPHALOPATHY vs WERNICKE-KORSAKOFF SYNDROME Wernicke's Encephalopathy -Opthalmoplegia (nystagmus and lateral rectus palsy), ataxia, and disturbances of consciousness or mental activity (ALL 3 seen i

by Alyssa Cocchiara, DO
Sunday Scaries

Burns – Sunday Scary

In honor of Thanksgiving Week this week's Sunday Scaries is going to highlight burns. Mostly because I so desperately want to deep fry a Turducken, hopefully without sinching my eyebrows! THE CASE: 28M old came in for "second degree burn" after having climbed into the bathroom sink, burning the lateral aspect of her left leg down to the foot (looking almost like de-gloving of the skin). Aside from getting ACS involved (strange and extensive burns in children must be reported), the burn team was called for debridement and evaluation of the wound. It had me thinking of

by Alyssa Cocchiara, DO
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