Fact of the Day - May 2013
May 24, 2013
The risk/benefit of active ventilation during the onset phase of muscle relaxants must be carefully assessed in each patient. In patients at low risk for desaturation (>95% saturation), manual ventilation is not necessary. In patients at higher risk (91% to 95% saturation), a risk-benefit assessment should include an estimation of desaturation risk and the presence of pulmonary pathology. In hypoxemic patients, low-pressure, low-volume, low-rate ventilations will be required.Ann Emerg Med. 2012;59:165-175
May 23, 2013
Differential Diagnosis For Children With Altered Mental Status : AEIOU Tips:
- Alcohol abuse
- Electrolytes, encephalopathy
- Infection
- Overdose
- Uremia
- Trauma
- Insulin/hypoglycemia, intussusceptions, inborn errors of metabolism
- Psychogenic (rare in young children)
- Seizures, shock, shunt
Pediatric Emergency Medicine Practice, 2011, ebmedicine.net
May 22, 2013
Clinical indicators of potential bladder injury:
- Suprapubic pain or tenderness
- Free intraperitoneal fluid on CT or ultrasonographic examination
- Inability to void or low urine output
- Clots in urine
- Signs of perineal or genital trauma
- Unresponsive, intoxicated, or altered sensorium
- Preexisting bladder disease or urologic surgery
- Abdominal distention or ileus
Emerg Med Clin N Am 29 (2011) 501–518
May 21, 2013
Intussusception is not a likely diagnosis in children over 3 years of age and is rare in children older than age 5. In 10% to 20% of children who do have intussusception, diarrhea will be present, and vomiting occurs 60% to 80% of the time.Pediatric Emergency Medicine Practice, 2012, ebmedicine.net
May 20, 2013
Results from retrospective study demonstrated a negative association between pre-hospital ETI attempts and survival from OOHCA. Individuals having no ETI were 5.46 (95% CI?= 3.36 to 8.90) times more likely to be discharged from the hospital alive compared to individuals with one successful ETI attempt. The individuals most likely to have pre-hospital ROSC and survival to hospital discharge were those who did not have a reported ETI attempt.Acad Emerg Med. 2010 Sep;17(9):918-25
May 19, 2013
Changes to the 2010 AHA Guidelines for resuscitation and emergency care of children:
- The dose of intratracheal administration of epinephrine is suggested to be 10 times the intravenous dose.
- The dose of intratracheal administration of atropine is increased to 0.04–0.06 mg/kg
- The routine use of sodium bicarbonate is discouraged during resuscitation
- The role of vasopressin is not clear, but there is more support for its use during refractory CA
- Lidocaine use is no longer specifically recommended for the treatment of VF/VT
Emerg Med Clin N Am 30 (2012) 153–168
May 18, 2013
Lorazepam is the drug of choice in alcoholic patients who have had a seizure or who are demonstrating signs of withdrawal. Alcoholic patients who have had a seizure should generally be observed for 4 to 6 hours and, if discharged, referred to a detoxificaton/rehabilitation program, if possible.Emerg Med Clin N Am 29 (2011) 117–124
May 17, 2013
Treatable causes of diaphragmatic dysfunction include myopathies related to metabolic disturbances such as hypokalemia, hypomagnesemia, hypocalcemia, and hypophosphatemia. Correction of electrolyte and hormonal imbalances and avoidance of neuropathic or neuromuscular blocking agents can restore diaphragmatic strength.N Engl J Med 2012;366:932-942
May 16, 2013
Headache or migraine is a presenting symptom in 57% to 92% of carotid artery dissections and 69% to 72% of vertebral artery dissections.EBmedicine.net, April 2012
May 15, 2013
When compared to ultrasound for the diagnosis of acute cholecystitis, HIDA has better sensitivity (88% vs. 50%), specificity (93% vs. 88%), positive predictive value (85%vs 64%), negative predictive value (95% vs. 80%), and accuracy (92% vs. 77%).
American Journal of Emergency Medicine (2011) 29, 91–101
May 14, 2013
Characteristics of the Ketamine "Dissociative State":
- Dissociation
- Catalepsy
- Analgesia
- Amnesia
- Maintenance of airway reflexes
- Cardiovascular stability
- Nystagmus
Ann Emerg Med. 2011;57:449-461
May 13, 2013
A randomized, single-blind, crossover, prospective study of 70 critically ill adult patients demonstrated that nebulized albuterol and ipratropium do not cause significant tachycardia or tachyarrhythmias. Substitution of levalbuterol for albuterol to avoid tachycardia and tachyarrhythmias is unwarranted.
Chest, Volume 140, Issue 6 (December 2011)
May 12, 2013
In ED record review of 111 discharged patients receiving warfarin, 71% of patients had an international normalized ratio measured, with 49% of values non-therapeutic and 46% with any record of recognition or action. Physicians administered or prescribed potentially interacting drugs for 17% and 13% of patients, respectively.
Ann Emerg Med. 2011;58:192-199
May 11, 2013
In hemodynamically unstable patients (systolic blood pressure <90 mm Hg) with blunt abdominal trauma, bedside ultrasound, when available, should be the initial diagnostic modality performed to identify the need for emergent laparotomy.
Ann Emerg Med. 2011;57: 387-404
May 10, 2013
Topical nonsteroidal anti-inflammatory drugs effectively reduce pain associated with musculoskeletal conditions compared with placebo, with fewer adverse events compared with oral nonsteroidal anti-inflammatory drugs.Annals of Emergency Medicine, 2012;59 (4)
May 09, 2013
Discordant diagnoses in a retrospective cohort study between emergency physicians and neurologists were observed in 36% of patients. The presence of headache, involuntary movement, and dizziness predicted discordant diagnoses, whereas the presence of tingling and an increased ABCD2 score predicted concordant transient ischemic attack diagnosis.Ann Emerg Med. 2012;59:19-26
May 08, 2013
Common ED Uses For Ketamine:
| In the ED | Other Indications |
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EBMedicine.net, January 2011
May 07, 2013
The clinical diagnosis of delirium hinges on the presence of two cardinal features: disruption of attention and disruption of the sleep–wake cycle, which leads to fluctuation in symptoms over the course of a day.N Engl J Med 2012;366:648-657
May 06, 2013
In acute methanol overdose, ophthalmologic symptoms can range from blurry vision, decreased visual acuity, and photophobia to blindness or the classic “snowstorm” vision.EBMedicine.net, 2010, Volume 12, Number 11
May 05, 2013
The combination of these 3 examination findings (head impulse test, skew deviation, and spontaneous nystagmus direction) appears to be more sensitive than MRI in acute vertigo.Mayo Clin Proc 2012;87(3):280-5
May 04, 2013
Pyuria in a urine specimen, in the absence of symptoms, is not an indication for antimicrobial therapy.EBMedicine.net, January 2012
May 03, 2013
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Advantages and Disadvantages of VKAs (Vit K Antagonists):
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Advantages
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Disadvantages
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Proven high effectiveness
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Monitoring of INR
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Therapeutic window established
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Drug interactions
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Antidote(s) established
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Food interactions
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Long action: low thrombosis risk
with poor compliance
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Slow onset of action
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High bleeding risk
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Emedhome.com, February 1, 2012
May 02, 2013
After out-of-hospital cardiac arrest, therapeutic hypothermia was associated with an increased risk of early-onset pneumonia. This complication was associated with prolonged respiratory support and ICU stay, but did not significantly influence ICU mortality.Am J Respir Crit Care Med 2011 Nov 1; 184:1048