The differential diagnosis for patients presenting with headache is large. This excellent website (https://ddxof.com/) provides algorithms to help consider the differential diagnosis in the cardinal EM presentations.
Sub-acute onset anemia secondary to chronic blood loss e.g menorrhagia, chronic GI bleed, etc can present with fatigue, visual disturbance and headache.
Tips:
Patients who present to ED with a new headache (no previous hx of primary headache syndrome or change in symptoms) should have baseline investigations including CBC and Glucose.
Always review the paramedic and triage notes for supplementary information and the presence of additional symptoms that may broaden or narrow the differential.
Patient ethnicity and skin colour may mask the presence of anemia.
Epistaxis – Posterior Bleed
Posterior epistaxis is a difficult condition to manage and is associated with a number of acute and serious complications. In this study, 3.7% required intubation.
The #FOAM Blog post provides an excellent outline to the management of posterior epistaxis – EMDocs.net
All cases of major bleeding, including epistaxis should be initially managed in the highest acuity areas of the ED. Patients can then be rapidly stepped down and relocated to lower acuity areas if determined to be lower risk after initial assessment.
Consider using a suction device to aid intubation in cases of massive obscuring oro/naso-pharynx haemorrhage.
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Question 1 of 5
1. Question
What is the most common source of posterior epistaxis?
Correct
Answer B. Posterior epistaxis arises most commonly from the posteriorlateral branches of the sphenopalatine artery but can also arise from the carotid artery.
Incorrect
Answer B. Posterior epistaxis arises most commonly from the posteriorlateral branches of the sphenopalatine artery but can also arise from the carotid artery.
Question 2 of 5
2. Question
What are the next possible steps in treatment of posterior epistaxis if packing fails?
Correct
All of the above are possible treatments if packing fails depending on clinical scenario. Surgical treatment is often performed endoscopically and can include ligation of the sphenopalatine or anterior ethmoid artery. Angiographic embolization is increasingly common, with results that approximate those of surgical treatment (90 percent range). The rate of severe complications (eg, stroke, blindness) with embolization is approximately four percent. Depending on patient stability observation with admission may be appropriate.
Incorrect
All of the above are possible treatments if packing fails depending on clinical scenario. Surgical treatment is often performed endoscopically and can include ligation of the sphenopalatine or anterior ethmoid artery. Angiographic embolization is increasingly common, with results that approximate those of surgical treatment (90 percent range). The rate of severe complications (eg, stroke, blindness) with embolization is approximately four percent. Depending on patient stability observation with admission may be appropriate.
Question 3 of 5
3. Question
In developing countries what is the approximate prevalence for H. Pylori infection by the age of 50?
Correct
Answer D. In developing nations, the majority of children are infected with H. pylori before the age of 10 and adult prevalence peaks at more than 80 percent before age 50. In contrast, in developed countries such as the United States, serologic evidence of H. pylori is uncommon before age 10, increasing to 10 percent in those between 18 and 30 years of age, and to 50 percent in those older than age 60.
Incorrect
Answer D. In developing nations, the majority of children are infected with H. pylori before the age of 10 and adult prevalence peaks at more than 80 percent before age 50. In contrast, in developed countries such as the United States, serologic evidence of H. pylori is uncommon before age 10, increasing to 10 percent in those between 18 and 30 years of age, and to 50 percent in those older than age 60.
Question 4 of 5
4. Question
In the elderly patient presenting with chest pain, what other system should be considered in the DDx?
Correct
Answer B. Elderly patients usually present in atypical fashion. Depending on the clinical scenario all above could be correct but an abdominal exam should always be done on the elderly patient presenting with chest pain.
Incorrect
Answer B. Elderly patients usually present in atypical fashion. Depending on the clinical scenario all above could be correct but an abdominal exam should always be done on the elderly patient presenting with chest pain.
Question 5 of 5
5. Question
The conservative estimate (i.e it’s probably higher than this in the real world) of error rates for radiologist diagnostic imaging reports is?
Correct
Although radiologists are highly skilled, like any physician, they are not infallible. Conservative estimates suggest an error rate of 4%. This will vary between individuals and in different hospitals.
Incorrect
Although radiologists are highly skilled, like any physician, they are not infallible. Conservative estimates suggest an error rate of 4%. This will vary between individuals and in different hospitals.
