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Category: Hematology

ANEMIA: LOOK AT THE TONGUE, EYES, AND HANDS

ANEMIA: LOOK AT THE TONGUE, EYES, AND HANDS

A patient presents with a gastrointestinal hemorrhage. Can you predict anemia from the physical examination? The short answer is yes, but not very well. A review of the current literature reveals that the results are mixed. Sensitivity is often below 50% and specificity varies enough that we can’t totally trust the bedside finding of pallor. Most of these studies were done on outpatient populations with varying hemoglobin levels defining anemia. At the bedside, you look at the conjunctival rim, the…

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BEDSIDE DIAGNOSIS OF COAGULOPATHY

BEDSIDE DIAGNOSIS OF COAGULOPATHY

A patient presents found in the rural backcountry after a motor vehicle accident. She has a grade V liver laceration and is not stable for transfer. Your general surgeon is getting ready to take her to the operating room for damage control laparatomy and packing. You notice she is oozing from her central line site. Could this indicate a consumptive coagulopathy? How reliable is the bedside diagnosis of coagulopathy? There is not sufficient evidence to answer this question in an…

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SPLENOMEGALY: PALPATE FOR THE SPLENIC EDGE

SPLENOMEGALY: PALPATE FOR THE SPLENIC EDGE

A patient presents with fever.  After the history, you suspect leukemia.  Is there splenomegaly?   Percussion: The chest wall should be tympanitic at the costal margin of the anterior axillary line. Dullness is abnormal and is taken to indicate splenomegaly. This test is neither sensitive nor specific but it does have some value.   Palpation: Any palpation of the spleen is abnormal.  It is easiest to feel the edge as it ballots against the volar fingers.  Approach from the left…

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PHYSICAL DIAGNOSIS OF PURPURIC LESIONS

PHYSICAL DIAGNOSIS OF PURPURIC LESIONS

You evaluate a patient with a rash, and as you look, you notice small patches of purple lesions that are circular in distribution.  You recognize what appears to be purpura.  The differential diagnosis is long, and includes hematologic, infectious, and immune mediated conditions.  How can we use physical diagnosis to narrow the differential diagnosis at the bedside? Blanching: Intravascular vrs extravascular First, apply pressure to see if it blanches.  Dermatologists use glass and call it diascopy.  In the ED we…

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