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American Academy of Emergency Medicine

Fact of the Day - November 2014

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

November 26, 2014

CT findings of chronic sinusitis in patients with atraumatic headache may be incidental, rather than causal. Studies of both adult and pediatric populations have found the rate of incidental sinus abnormalities on CT scans of asymptomatic patients of approximately 30–40%.

Kroll KE, Camacho MA, Gautam S, Levenson RB, Edlow JA. Findings of Chronic Sinusitis on Brain Computed Tomography Are Not Associated with Acute Headaches. The Journal of Emergency Medicine. Volume 46, Issue 6, June 2014, Pages 753–759.

November 25, 2014

No absolute contraindications to the use of epinephrine for anaphylaxis have been identified. Epinephrine is the drug of choice and should be administered as soon as the diagnosis is suspected. For patients who do not respond to repeated i.m. injections, a continuous infusion should be started. Antihistamines and corticosteroids are second-line medications and should never be given in lieu of, or prior to, epinephrine.

Zilberstein J, McCurdy M, Winters M. Anaphylaxis. The Journal of Emergency Medicine. Volume 47, Issue 2, August 2014, Pages 182–187.

November 24, 2014

Undiagnosed Kawasaki Disease may present in teenagers with myocardial ischemia due to coronary artery aneurysms.

Mirza SJ, Mohammed KO, Baslaib FO. Myocardial Infarction in a Young Man Due to Coronary Artery Aneurysms after an Undiagnosed Kawasaki Disease. The Journal of Emergency Medicine. Volume 46, Issue 6, June 2014, Pages 763–766.

November 23, 2014

Diagnosis of Kawasaki's Disease is fever >103 for 5 days AND 4/5 of: bilateral conjunctivitis (90%), oral lesions, neck nodes, palm&sole rash, torso rash.

Pregerson, Brady. EMResource.org

November 22, 2014

Laboratory values consistent with Kawasaki's Disease: ESR>40, CRP>3, WBC>15, platelets>450k, albumin<3, anemia, pyuria

Pregerson, Brady. EMResource.org

November 21, 2014

Kawasaki's Disease therapy: IVIG 2g/kg + ASA 20mg/kg QiD. Err on the side of early treatment (<7days), especially if <1 year old. Goal is to start IVIG prior to abnormalities on Echo or EKG. Steroids controversial: some give if refractory (fever lasts >48h after IVIG) or GI complications.

Pregerson, Brady. EMResource.org

November 20, 2014

Complications of Kawasaki's Disease: coronary aneurysms-->myocardial infarction: 25% of untreated and 5% of treated, cholecystitis, pancreatitis, hepatitis, orchitis, meningitis, vasculitis

Pregerson, Brady. EMResource.org

November 19, 2014

Major differential diagnosis for Kawasaki's Disease: Drug reaction, viral illness, Rocky Mountain Spotted Fever, measles, scarlet fever, rheumatologic, leptospirosis

Pregerson, Brady. EMResource.org

November 18, 2014

Most low-income countries lack prehospital care systems and must rely on preexisting infrastructure to transport acute patients to the ED; in one study, 335 taxi and bus drivers showed significant improvements in airway management, extrenal hemorrhage control, and splinting after attending a first aid course.

M Tiska, M Adu-Ampofo, G Boakye, L Tuuli, and C Mock. A model of prehospital trauma training for lay persons devised in Africa. Emerg Med J. Mar 2004; 21(2): 237–239.

November 17, 2014

In patients in whom palpation of the cricothyroid membrane is difficult (eg an obese patient with Ludwig's angina), ultrasound can help with the rapid identification of anatomical structures to secure an airway.

Nicholls SE, Sweeney TW, Ferre RM, Strout TD. Bedside sonography by emergency physicians for the rapid identification of landmarks relevant to cricothyrotomy. Am J Emerg Med. 2008;26:852–856.

November 16, 2014

Cardiovascular disease, cancer, trauma, and stroke have overtaken communicable diseases in causes of morbidity and mortality around the world.

Mathers CD, Loncar D. World Health Organization Report. Geneva, Switzerland; 2006. Updated projections of global mortality and burden of disease, 2002-2030: 237.

November 15, 2014

Emergency medicine is an officially recognized specialty in over 60 countries worldwide.

Anderson P, Hegedus A, Ohlen G, Holliman CJ, Williams D, Suter R. Worldwide growth of Emergency Medicine as a recognized medical specialty. Acad Emerg Med. 2011;18(5):S22–S23.

November 14, 2014

On lung ultrasound, "comet-tail" artifacts represent the interlobular septae under the visceral pleura; loss of these artifacts suggests a pneumothorax, though the presence of even one comet-tail can essentially rule out a pneumothorax.

Lubna F Husain, Laura Hagopian, Derek Wayman, William E Baker, and Kristin A Carmody. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock. 2012 Jan-Mar; 5(1): 76–81.

November 13, 2014

In resource-limited settings, emergency ultrasound can be useful for detecting cerebral abscesses in children presenting with convulsions or in a coma.

S Ahmad, S Kampondeni, and E Molyneux. An experience of emergency ultrasonography in children in a sub‐Saharan setting. Emerg Med J. May 2006; 23(5): 335–340.

November 12, 2014

An optic nerve sheath diameter of over 5.0 mm as detected on ocular ultrasound is suggestive of elevated intracranial pressure in adults (>4.5 mm in children 1-15 years old, >4.0mm in infants <1 year old).

Tsung JW, Blaivas M, Cooper A, Levick NR. A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care. 2005 Feb;21(2):94-8.

November 11, 2014

Sub-Saharan Africa has the highest rate of burn injuries in the world, yet has the fewest available emergency burn care facilities.

Mock C, Peck M, Peden M, Krug E, eds. A WHO plan for burn prevention and care. Geneva: World Health Organization; 2008.

November 10, 2014

Emergency surgical care could be up to 10 times more cost-effective in saving lives in developing countries than controlling infectious diseases like HIV.

Debas H, Gosselin R, McCord C, et al. Surgery. In: al. Jamison D, ed. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: World Bank; 2006.

November 09, 2014

Injuries such as road traffic crashes and drowning account for more deaths around the world than malaria, TB, and HIV/AIDS combined.

Injuries and violence: the facts. Geneva, World Health Organization, 2010.

November 08, 2014

NIPPV initiated in the field results in faster physiologic improvement and may decrease the need for intubation compared with delayed NIPPV in the ED.

Mal MD, Sameer, McLeod MSc, Shelley, et. al. Annals of Emergency Medicine. 2014: Volume 63 Number 5: Pg 605

November 07, 2014

Right ventricle dilation on bedside Echo is highly specific for pulmonary embolism (98%) but had poor sensitivity (50%).

Wang MD, Henry, Yealy MD, Donald. Annals of Emergency Medicine. 2014: Volume 63 Number 1: Pg 22

November 06, 2014

Older adults discharged from the ED with unidentified delirium are at greater risk for death in the next 6 months than those whose delirium was identified.

Lamantia MD, MPH, Michael, Messina MD, Frank, et. al. Annals of Emergency Medicine. 2014: Volume 63 Number 5: Pg 558

November 05, 2014

Tranexamic acid significantly decreases mortality in bleeding trauma patients, with no significant increase in serious prothrombotic complications if given withing 3 hours of injury.

Harvey MD, Virginia, Perrone MD, JeanMarie, Kim MD, Patrick. Annals of Emergency Medicine. 2014: Volume 63 Number 4: Pg 462

November 04, 2014

10.9% of patients who recieve a misdiagnosis of Bell's Palsy received a diagnosis of Guillan Barre syndrome on 90 day follow up

Fahimi MD, Jahan, Navi MD, Babak, Kamel MD, Hooman. Annals of Emergency Medicine. 2014: Volume 63 Number 4: Pg 432

November 03, 2014

Topically applied anesthesia is as effective as infiltration anesthesia for pain relief or lacerations.

Jenkins MBChB, Mark, Murphy PhD,Diarmaid, et. al. Annals of Emergency Medicine. 2014: Volume 63: Pg 709

November 02, 2014

There is no advantage to weight based pain medication dosing and the more common fixed initial dose.

Xia MD, Shujun, Choe MD, Dong, et al. Annals of Emergency Medicine. 2014: Volume 63: Pg 695

November 01, 2014

The Flush the Line and Ultrasound the Heart (FLUSH) method is highly accurate in confirming the placement of femoral venous lines.

Horowitz MD, Russ Gossett MD, Jeffrey, et al. Annals of Emergency Medicine. 2014: Volume 63: Pg 678