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American Academy of Emergency Medicine

Fact of the Day - December 2014

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

December 21, 2014

IV lipid emulsion pretreatment decreases cocaine-associated hemodynamic collapse and blunts hypotensive effects compared with normal saline in rat models of acute lethal cocaine intoxication.

Carreiro S, Blum J, Hack JB. Pretreatment with intravenous lipid emulsion reduces mortality from cocaine toxicity in a rat model. Ann Emerg Med. 2014;64(1):32-7.

December 20, 2014

Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful.

Lindor RA, Campbell RL, Pines JM, et al. EMTALA and Patients With Psychiatric Emergencies: A Review of Relevant Case Law. Ann Emerg Med. 2014;

December 19, 2014

Traumatic brain injury on CT is uncommon and clinically important TBI is very uncommon in children with minor blunt head trauma when vomiting is the only indicating symptom.

Dayan PS, Holmes JF, Atabaki S, et al. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med. 2014;63(6):657-65.

December 18, 2014

Ketamine sedation in children with healthy eyes can produce mild increases in intraocular pressure that at times transiently increases accepted bounds of for potential clinical importance.

Wadia S, Bhola R, Lorenz D, Padmanabhan P, Gross J, Stevenson M. Ketamine and Intraocular Pressure in Children. Ann Emerg Med. 2014;

December 17, 2014

The implementation of health care reform in the state of Massachusetts was associated with a consistent increase in the use of the ED across the state.

Smulowitz PB, O'malley J, Yang X, Landon BE. Increased use of the emergency department after health care reform in massachusetts. Ann Emerg Med. 2014;64(2):107-115.e3.

December 16, 2014

Text message intervention could serve as a useful alternative to opportunistic brief in-person ED intervention for producing small reductions in self-reported binge drinking in young adults.

Suffoletto B, Kristan J, Callaway C, et al. A Text Message Alcohol Intervention for Young Adult Emergency Department Patients: A Randomized Clinical Trial. Ann Emerg Med. 2014;

December 15, 2014

Among a random sample of cognitively intact elderly ED patients in the southeastern United States, more than half were malnourished or at risk for malnutrition.

Pereira GF, Bulik CM, Weaver MA, Holland WC, Platts-mills TF. Malnutrition Among Cognitively Intact, Noncritically Ill Older Adults in the Emergency Department. Ann Emerg Med. 2014;

December 14, 2014

IV metoprolol administration by EMS within 4-5 hours of symptom onset in STEMI patients reduced infarct size and improved left ventricular ejection fraction.

Mateos A, García-lunar I, García-ruiz JM, et al. Efficacy and Safety of Out-of-Hospital Intravenous Metoprolol Administration in Anterior ST-Segment Elevation Acute Myocardial Infarction: Insights From the METOCARD-CNIC Trial. Ann Emerg Med. 2014;

December 13, 2014

Catamenial pneumothorax is a spontaneous, recurrent pneumothorax occurring with menses – it may be caused by endometriosis of the pleura and can respond to ovulation-suppressing medications.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010, p939.

December 12, 2014

Heat edema, foot and ankle swelling caused by rapid entry into a hot climate, is common in the elderly, and can occur even in patients without underlying cardiac, hepatic, venous, or lymphatic pathology.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010, p1886

December 11, 2014

At a Potassium level of 2.5, patients can experience lethargy, depression, irritability, confusion, parasthesias, depressed DTRs, fasciculations, myalgias, and muscle weakness. Muscular paralysis can occur when K drops below 2.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010, p1620.

December 10, 2014

Physicians should be aware of signs of elder abuse, especially in patients residing in nursing homes: in one survey of employees of long-term care institutions, 10% of aides reported to committing acts of physical violence against patients.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010, p836.

December 09, 2014

The Reflex Sympathetic Response to Laryngoscopy, a catecholamine surge in response to intubation, has minimal effect on the outcomes of most patients, but can be dangerous in the setting of acutely elevated ICP, intracerebral or subarachnoid hemorrhage, aortic dissection, or ischemic heart disease.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010, p16.

December 08, 2014

In the treatment of recurrent wheeze due to Respiratory Syncytial Virus in otherwise healthy preterm infants, palivizumab treatment resulted in a significant reduction in wheezing during the first year of life, even after the end of treatment.

"Blanken, M. & et al. Respiratory Syncytial Virus and Recurrent Wheeze in Healthy Preterm Infants. N Engl J Med 2013;368:1791-9."

December 07, 2014

"The management of Gamma Hydroxybutyric Acid (GHB) intoxication in a patient who is spontaneously breathing is primarily supportive and includes stabilization of the airway, establishment of intravenous access, oxygen supplementation, and administration of atropine for persistent bradycardia."

Snead, O. & Gibson, K. Gamma Hydroxybutyric Acid. N Engl J Med 2005;352:2721-32

December 06, 2014

When the skin absorbs ultraviolet radiation, sunburn occurs in the upper layers of the skin Consequently, as DNA is damaged, erythema then begins to appear several hours after exposure. In contrast, a thermal injury presents with erythema, blistering, and immediate denaturation of proteins and ultimately tissue necrosis.

Singer AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med 2008;359:1037-46.

December 05, 2014

More than 220,000 hospital admissions in the U.S. are cases acute pancreatitis. The clinical diagnosis is typically abdominal pain, nausea, and elevated levels of amylase and lipase.

Whitcomb, D. Acute Pancreatitis. N Engl J Med 2006;354:2142-50.

December 04, 2014

The typical clinical features of the recent chikungunya disease epidemic presents with an acute onset of fever, muscle and symmetric joint pains, lymphopenia, and a nonspecific maculopapular rash.

Morens, D.M. & Fauci, A.S. Chikungunya at the Door — Déjà Vu All Over Again?. NEJM. 2014 July; DOI: 10.1056/NEJMp1408509.

December 03, 2014

Terminal events such as cardiac or respiratory arrest should not be listed as the proximate cause of death [on death certificates], because they do not indicate the disease process that caused death.

Siff JE. Chapter 298. Legal Issues in Emergency Medicine. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. Page 2030.

December 02, 2014

Reimplant avulsed permanent teeth as soon as possible.[…] Early improper implantation holds a higher success rate for tooth salvage than delayed reimplantation resulting from waiting for arrival at the ED for an oral and maxillofacial surgeon.

Beaudreau RW. Chapter 240. Oral and Dental Emergencies. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. Page 1581.

December 01, 2014

Traditional cardiac risk factors for CAD, such as hypertension, diabetes mellitus, tobacco use, family history at an early age, and hypercholesterolemia, are not helpful to predict ACS in ED patients >40 years old […] cardiac risk factors for CAD have significantly less predictive value than the mere presence of symptoms.

Hollander JE, Diercks DB. Chapter 53. Acute Coronary Syndromes: Acute Myocardial Infarction and Unstable Angina. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. Page 369.