Kyle Buchwalder

[Kyle Buchwalder @BuchwalderKyle]

When treating a patient with otitis externa, consider placing a wick to ensure that antibiotic ear drops are able to penetrate into the ear canal! #cincyai

[Kyle Buchwalder @BuchwalderKyle]

Transient Global Amnesia is a rare (and interesting) cause of AMS. Patients with TGA typically present between 40 and 80 years of age with sudden onset severe anterograde amnesia, repetitive questioning, and disorientation to time and place without focal neuro deficits! #cincyai

[Kyle Buchwalder @BuchwalderKyle]

In a patient with suspected lumbar disc herniation, keep in mind that the straight leg raise test has poor sensitivity, only 40-50%! Slump test has greater sensitivity for the diagnosis. #CincyAI

[Kyle Buchwalder @BuchwalderKyle]

T-wave inversions in an elderly individual with AMS? Don’t limit the differential to cardiac ischemia, consider the possibility of increased intracranial pressure with cerebral T-waves on EKG! #CincyAI
https://t.co/fg5Ln6vDM9

[Kyle Buchwalder @BuchwalderKyle]

When evaluating a patient for possible vaginitis, keep in mind that wet prep has good specificity, but poor senistivity for Bacterial Vaginosis, Trichomoniasis and candidal infections! #cincyai

[Kyle Buchwalder @BuchwalderKyle]

Trying to find a nerve using ultrasound? Anisotropy can help to identify fibrillar structures such as nerves. When perpendicular to the ultrasound beam, nerves will appear hyperechoic. However, if the angle of the beam is flattened, they will become hypoechoic. #CincyAI

[Kyle Buchwalder @BuchwalderKyle]

When choosing between these decision making tools, remember that both CCHR and NOC have high sensitivities for neurosurgical intervention and clinically important brain injury, but CCHR has higher specificity for important clinical outcomes! #Cincyai
https://t.co/HX6wLlii7r

[Kyle Buchwalder @BuchwalderKyle]

Both the Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) may be used to evaluate the need for imaging following head trauma. #Cincyai
https://t.co/T6bIvKMVwq
https://t.co/P79AXW5lwa

[Kyle Buchwalder @BuchwalderKyle]

When faced with a laceration of the upper lip, consider performing an infraorbital nerve block rather than local infiltration of anesthetic. In appropriate cases, nerve blocks may allow for improved anesthesia, use of less anesthetic, and decreased distortion of tissue. #Cincyai

[Kyle Buchwalder @BuchwalderKyle]

Concerned about infectious tenosynovitis? Look out for Kanavel's signs!
1. Fusiform digital swelling
2. Digital flexion at rest
3. Pain with passive extension
4. Tenderness to palpation along the flexor tendon sheath
#Cincyai

[Kyle Buchwalder @BuchwalderKyle]

When performing lower extremity venous ultrasound to assess for DVT, positioning is critical. If you can't visualize the popliteal vein with the patient's leg externally rotated, have them lay prone or on their side to get an improved view. #Cincyai

[Kyle Buchwalder @BuchwalderKyle]

Bug in the ear? Try using 1% Lidocaine to immobilize the insect prior to removal! #Cincyai

[Kyle Buchwalder @BuchwalderKyle]

Ellis classification of tooth fractures
Class I = only enamel -> Routine referral
Class II =enamel and dentin -> Next day referral, consider CaOH
Class III = enamel, dentin, and pulp ->Immediate referral, consider CaOH as well as dental cement and antibiotics
#Cincyai

[Kyle Buchwalder @BuchwalderKyle]

In lacerations anterior to the ear, patients should be evaluated for damage to the parotid gland, duct, and facial nerve prior to closure. Evaluation by a specialist should be considered. #cincyai

[Kyle Buchwalder @BuchwalderKyle]

In cases of valproic acid toxicity, L-carnitine administration should be considered as carnitine deficiency may play a role in the development of hyperammonemia and hepatotoxicity in these patients. #cincyai
https://t.co/uavIwRrldK