AJ Hanna
@AJHanna1M4 @cincymedicine | #DiversityInMedicine 🇪🇹🇿🇦 | Diehard LeBron fan | Music lover |
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All the people that were telling me to “keep politics out of sports”, (which it wasn’t political at all), really inspired me to win. You better believe I’m gonna try to be on your tv for as long as possible.
When suturing a lip laceration that involves the vermillion border, the first stitch should be placed at the border as this is the most important area to line up! Infraorbital nerve blocks can be better than local analgesia so as to not distort the border! #CincyAI
Just because a patient is triaged into a “minor care” area does not mean there is nothing emergent going on. It’s always important to do a complete evaluation on patients and be on the lookout for red flag symptoms! #CincyAI
About 50% of Americans are seropositive for CMV, however, symptomatic patients are typically immunosuppressed. CMV can cause issues all over the body - esophagitis, retinitis, colitis, pneumonia, and encephalitis #CincyAI
In patients presenting with high suspicion for an Ulcerative Colitis flare, IV steroids are first line, however if patients do not respond you can try giving infliximab or cyclosporine! #CincyAI
Sensitivity of CXR in detecting rib fractures is quite low, some studies citing around ~50%. If you have a patient you’re suspecting fracture in but CXR neg, treat them like a fracture! Get them on IS and advise them on effective ways to treat their pain. #CincyAI
In HDS patients with SVT, first attempt valsava maneuvers to treat, if this does not work try 6mg adenosine. If this still does not work, can give 12mg adenosine. If your patient is still in SVT, you can try adenosine again or put on diltiazem drip #CincyAI
Lung ultrasounds have higher sensitivity for picking up pneumothorax than CXR does, look for the absence of lung sliding on your ultrasound #CincyAI
Open globe injuries are very serious and need emergent ophthalmology consults for surgical repair. In the meantime, it’s very important to control nausea and pain in these patients as vomiting can cause expulsion of vitreous fluid from the eye! #CincyAI
Patients in the ED w significantly elevated BP should be evaluated for signs of end-organ dysfunction (dissection, angina, volume overload, respiratory distress, focal neuro deficits, AMS, seizures, SAH, oliguria, or elevated Cr) and if none present, no need to treat! #CincyAI
Patient presenting with a scalp wound? Consider using the hair apposition technique as a fast and cost-effective method of closing the wound. No analgesia necessary and patients don’t have to return to get staples taken out, the hair just untangles on its own! #CincyAI
Ingestion of foreign objects is usually managed conservatively. Some indications for urgent endoscopy are esophageal obstruction, evidence of perforation, ingestion of batteries, long sharp objects, objects >6cm, or two or more magnets! #CincyAI
From @cczalesky: SGLT-2 inhibitors cause glucose wasting through the urine, resulting in decreased insulin levels and increased ketosis. These patients are always in a small amount of ketosis, making them easy to tip over into DKA and high risk for GU infections.
Euglycemic DKA is a rare condition that presents similarly to classical DKA with anion gap acidosis and ketosis, however these patients have glucose <200. Keep this in your differential when your patient is on an SGLT2 inhibitor, and treat them like you would DKA! #CincyAI
In young, healthy appearing patients presenting with syncope, some EKG findings to look out for are LVH (HOCM), delta waves (WPW), long QT, epsilon waves (ARVC), and Brugada syndrome pictured below. #CincyAI
Dyspneic patient with history of CHF and COPD? Lung sonography at bedside can be a fast and efficient way to help determine the source of their shortness of breath, look for those B lines! #CincyAI
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