EM Quick Hits 69 Pediatric Urinary Retention & Acute Transverse Myelitis, Post-Dural Puncture Headache, Med Mal Cases: Clenched Fist Injury, IV Thrombolysis for Minor Stroke, EM Leadership Spotlight #4
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Dec 2, 2025 In this insightful discussion, Deborah Schoenfeld, a pediatric emergency medicine educator, dives into the complexities of pediatric urinary retention and acute transverse myelitis, outlining key diagnostic strategies. Matthew McArthur, an expert in headache management, reviews the nuances of post-dural puncture headaches, emphasizing prevention and treatment. Joseph Yasmeh presents a compelling medico-legal analysis of clenched fist injuries, detailing common pitfalls in management. Brit Long tackles the controversial use of IV thrombolysis for minor strokes, while Lauren Westaffer shares invaluable mentorship and leadership strategies for emerging physicians.
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Use Non-Cutting Small Needles For LPs
- Prevent post-dural puncture headache by using non-cutting (pencil-tip) needles of 25G or smaller for lumbar puncture.
- If forced to use a cutting needle, orient the bevel longitudinally and use the smallest gauge possible.
Stepwise Management Of Post-Dural Puncture Headache
- Manage conservatively with oral hydration, NSAIDs/acetaminophen, ± short opioids and consider caffeine within 24 hours for relief.
- Offer epidural blood patch for severe or refractory cases and consider occipital or sphenopalatine blocks for temporary relief.
Classic Fight Bite That Masquerades As Minor Cut
- An 18-year-old presented with a tidy 1cm dorsal knuckle laceration and a dubious story about a falling brick.
- Joseph Yasmeh warns that this pattern is classic for a clenched-fist (fight bite) injury despite the patient's story.
