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American Academy of Emergency Medicine

Fact of the Day - March 2015

Brought to you by the AAEM Resident & Student Association (AAEM/RSA)

March 14, 2015

Treatment for an aortic dissection, it is important to give the beta blocker prior to the vasodilator to reduce the sheer force on the aorta.

1. Suzuki T, Isselbacher EM, Nienaber CA, et al: Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]). Am J Cardiol109: 122, 2012. [PubMed: 21944678] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/21944678> 2. Nienaber CA, Powell JT: Management of acute aortic syndromes.Eur Heart J 33: 26, 2012. [PubMed: 21810861] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/21810861>

March 13, 2015

The primary goal of using US for an ectopic pregnancy is to rule in an IUP. Ultrasound cannot rule out ectopic pregnancy alone.

1. American College of Emergency Physicians: Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med 41: 123, 2003. 2. Dart R, Ramanujum P, Dart L: Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate. Am J Emerg Med 20: 575, 2002. [PubMed: 12442232] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/12442232> 3. Burgher SW, Tandy TK, Dawdy MR: Transvaginal ultrasonography by emergency physicians decreases patient time in the emergency department. Acad Emerg Med 5: 802, 1998. [PubMed: 9715242] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/9715242>

March 12, 2015

50-80% of the general population has cytomegalovirus antibodies, which can be a problem with immunosuppressed patients.

1. Dodd RY: Current viral risks of blood and blood products. Ann Med32: 469, 2000. [PubMed: 11087167] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/11087167> 2. Wright-Kanuth MS, Smith LA: Transfusion-transmitted viruses. Clin Lab Sci 16: 221, 2003. [PubMed: 14626440] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/14626440> 3. Allain JP, Stramer SL, Carneiro-Proietti AB, et al: Transfusion-transmitted infectious diseases. Biologicals 37: 71, 2009. [PubMed: 19231236] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/19231236>

March 11, 2015

Majority of uncomplicated diverticulitis resolves with bowel rest (liquid diet) and antibiotics (often cipro and flagyl) and can be discharged.

Detry R, Jamez J, Kartheuser A, et al: Acute localized diverticulitis: optimum management requires accurate staging. Int J Colorectal Dis35: 1123, 1992.

March 10, 2015

A good rescue devise in the pediatric population is the laryngeal mask airway (LMA).

1. Selim M, Mowafi H, Al-Ghamdi A, et al: Intubation via LMA in pediatric patients with difficult airways. Can J Anesth 46: 891, 1999. [PubMed: 10490160] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/10490160> 2. Grein AJ, Weiner GM: Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation.Cochrane Database Syst Rev CD003314, 2005. 3. Bortone L, Ingelmo PM, De Ninno G, et al: Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients. Paediatr Anaesth 16: 251, 2006. [PubMed: 16490088] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/16490088>

March 09, 2015

Lisfranc injuries have a classification system. The Nunley classification groups low-energy ligamentous injuries by diastasis and preservation or loss of arch height: type I are nondisplaced, type II involve diastasis between first and second metatarsal heads, and type III involve diastasis with loss of arch height.

1. Nunley JA, Vertullo CJ: Classification, investigation and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med 30: 871, 2002. [PubMed: 12435655] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/12435655> 2. Hardcastle P, Reschauer R, Kutscha-Lissberg E, Schoffman W: Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg Am 64: 349, 1982. [PubMed: 7096403] <http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/7096403>

March 08, 2015

Symptoms of Serotonin Syndrome can be subtle but may include autonomic dysfunction, myoclonus, muscular rigidity, behavior changes, flushed skin, tremor, or nystagmus. First line treatment includes stopping the offending agent(s) and starting benzodiazepines. Cyproheptadine, an antiserotoniergic medication, can be started in severe cases.

Mills KC, Bora KM. Atypical Antidepressants, Serotonin Reuptake Inhibitors, and Serotonin Syndrome. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.

March 07, 2015

The combination of rash, neutropenia, thrombocytopenia and elevated LFTs may suggest Rocky Mounted Spotted Fever and careful history should be taken on these patients.

Meredith JT. Zoonotic Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.

March 06, 2015

Patients less than 5 years with sickle cell disease (SCD) can present in shock due to acute splenic sequestration of red blood cells. Treatment consists mostly of blood transfusion.

McCreight AL, Wickiser JE. Chapter 100. Sickle Cell Disease. In: Strange GR, Ahrens WR, Schafermeyer RW, Wiebe RA. eds. Pediatric Emergency Medicine, 3e. New York, NY: McGraw-Hill; 2009.

March 05, 2015

Diaphoresis with feeds should prompt the emergency physician to consider undiagnosed congenital heart disease in a children presenting to the emergency department.

Horeczko T, Young KD. Chapter 47. Congenital Heart Disease. In: Strange GR, Ahrens WR, Schafermeyer RW, Wiebe RA. eds. Pediatric Emergency Medicine, 3e. New York, NY: McGraw-Hill; 2009.

March 04, 2015

Electrocardiogram findings of ST elevation may be present in infants with Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA). These patients usually present in the first 2 months of life and it is one of the most common causes of myocardial infarction in children.

Yue EL, Meckler GD. Congenital and Acquired Pediatric Heart Disease. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.

March 03, 2015

The most common cause of recurrent ataxia in children, is basilar artery migraine. However, initial evaluation in the emergency room should exclude more serious causes, including increased intracranial pressure, meningitis or encephalitis, and toxic ingestions.

Fuchs S. Chapter 54. Ataxia. In: Strange GR, Ahrens WR, Schafermeyer RW, Wiebe RA. eds. Pediatric Emergency Medicine, 3e. New York, NY: McGraw-Hill; 2009.

March 02, 2015

When done correctly, the HINTS (Head Impulse, Nystagmus, Test of Skew) is 100% sensitive and 96% specific for stroke in patients with acute vestibular syndrome.

Kattah, JC et al. "HINTS to diagnose stroke in the acute vestibularsyndrome: three-step bedside oculomotor examination more sensitive than early MRI diffused-weighted imaging." Stroke. 2009; 40:3504-3510.

March 01, 2015

Patients with ethylene glycol poisoning can have isolated cranial nerve injuries that may be due to crystalization of oxylate crystals in the cranial nerves.

Wiener SW. Chapter 107. Toxic Alcohols. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank's Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011