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American Academy of Emergency Medicine

Fact of the Day - July 2011

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

July 31, 2011

Ventricular Assist Devices have been associated with an increased incidence of monomorphic VT and, at times, these arrhythmias require treatment with catheter ablation.

J Cardiovasc Electrophysiol.  2011;22(3):359-363

July 30, 2011

Headache after lumbar puncture is a common occurrence (32%) and carries a considerable morbidity, with symptoms lasting for several days and if untreated, it can result in serious complications such as subdural hematoma and seizures, which could be fatal.

Postgrad Med J 2006;82:713-716.

July 29, 2011

Chest radiographs are prospectively interpreted as suggestive of the diagnosis in only 25% of aortic dissection cases.

Am J EM, Vo. 23, pg. 439

July 28, 2011

The diagnosis of hypertrophic cardiomyopathy must be considered when evaluating a teenage athlete in the ED for a syncopal event with the most specific ECG finding of Q waves in leads II, III, aVF, V5, and V6 in the early teenage years.

Am J EM, Vol. 25, pg. 688

July 27, 2011

Children with croup that are treated with nebulized epinephrine in the ED should be observed for at least 2 hours for a return of obstructive symptoms before discharge.

NEJM, Vol. 358. January 24, 2008

July 26, 2011

Staphylococcal scalded skin syndrome usually occurs in children, as adults have specific antistaphylococcal antibodies to excrete the staphylococcal toxin through adequate renal clearance.

Mayo Clin Proc, September 2009, pg. 838

July 25, 2011

If a healthy adult is preoxygenated with 100% oxygen and ventilating effectively and then becomes apneic, it will take 6 min before oxygen saturation decreases to less than 90%.

als of EM, July 2008, pg. 3

July 24, 2011

Magnesium sulfate is the first drug administered for treatment of eclampsia and is the mainstay for seizure control with the initial dose of 4 to 6 grams IV, followed by a drip at a dose of 2 grams per hour.

Journal of Emerg Med., Vol. 34, pg. 199

July 23, 2011

In patients with TIA referable to carotid stenosis, revascularization is beneficial with carotid stenosis of 70% or greater with lesser beneficial effect is seen for stenosis of 50% to 69%.

als of EM, Vol. 52:S27

July 22, 2011

Penicillins and sulfonamides are most commonly implicated as the cause of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Mayo Clin Proc, September 2009, pg. 838

July 21, 2011

Even in the presence of clinically signficant rhabdomylolysis, myoglobin may be undetectable in urine until after 6 hours.

Am J EM, September 2009, pg. 876

July 20, 2011

Disseminated gonorrhea presents with fever, skin lesions, tenosynovitis, polyarthralgias, and arthritis.

Mayo Clin Proc, Vol. 82, pg. 745

July 19, 2011

Primary biliary cirrhosis is a cholestatic liver disease of presumed autoimmune etiology that affects predominantly middle-aged women with antimitochondrial antibodies, the diagnostic hallmarks of PBC, are present in 95% of patients with PBC.

Mayo Clin Proc, June 2009, pg. 551

July 18, 2011

A chest tube thoracostomy needs to be placed 1 or 2 intercostal space higher than usual to avoid diaphragmatic injury in the setting of trauma in pregnant women.

EM Clinics NA, Vol. 21:615

July 17, 2011

Up to 40% of patients with SAH have been reported to have had a small warning bleed (or "sentinel leak") a short time before a larger bleed.

als of EM, Vol. 51, pg. 707

July 16, 2011

At doses typically used for rapid sequence intubation, succinylcholine causes motor paralysis that lasts 6-10 minutes.

Journal of Emerg Med., August 2009, pg. 186

July 15, 2011

Osmotic demyelination syndrome, a complication of the treatment of hyponatremia, appears to be directly related to the rate of rise of the serum sodium, thus recent guidelines recommend limiting correction of the serum sodium to 8mEq/L/24 hr to avoid osmotic demyelination syndrome.

EM Clin NA, Vol. 27;257

July 14, 2011

A Babinski reflex in the setting of the cauda equina syndrome suggests involvement of the conus medullaris, the lower part of the spinal cord which is in proximity to the nerve roots.

Journal of Emerg Med., Vol. 30, pg. 381

July 13, 2011

ACC/AHA guidelines state that an experienced EP should review the results of 12-lead ECG within no more than 10 minutes after arrival.

Mayo CLin Proc, October 2009, pg. 917

July 12, 2011

Noroviruses are recognized as being the leading cause of epidemics of gastroenteritis and an important cause of sporadic gastroenteritis in both adults and children.

NEJM 2009;361:1776

July 11, 2011

Contrast-induced nephropathy is usually transient, with serum creatinine levels peaking 3 days after adminstration of the contrast with the serum creatinine typically return to baseline within 10 days after contrast administration.

NEJM, Vol. 354, pg. 380

July 10, 2011

A prospective, randomized, active controlled, double-blinded study demonstrated that Prochlorperazine and ondansetron appear to be equally effective at treating vomiting in the emergency department.

Western J Emerg Med.  2011;12(1):1-5  

July 09, 2011

Magnesium is the initial medication of choice for treatment of torsades de pointes type of polymorphic ventricular tachycardia.

Am J EM, Vol. 25, pg. 973

July 08, 2011

Chance fracture  is a flexion injury of the spine consisting of a compression to the anterior vertebral body and a transverse fracture through the posterior elements of the vertebra and the posterior portion of the vertebral body.

Wheeless' Text of Orthopedics. Copyright © 1996-2009 Data Trace Internet Publishing, LLC

July 07, 2011

The hyperdense MCA sign is one of the early markers on CT scan of acute ischemic stroke.

  Journal of Emerg Med., Vol. 33, pg. 417

July 06, 2011

In 2009 alone, an estimated 25,000 fewer Central line-associated blood stream infections occurred in U.S. ICUs than in 2001, a 58% reduction which represents up to 6,000 lives saved and $414 million in potential excess health-care costs in 2009.

Morbidity & Mortality Weekly Report.  2011;60(8):243-248

July 05, 2011

When given orally for the treatment of hyperkalemia, the onset of action of sodium polystyrene is at least 2 hours and the maximum effect may not be seen for 6 hours or more.

Crit Care Med, 2008, Vol. 36, pg. 3249

July 04, 2011

Primary percutaneous coronary intervention in High-risk Patients with ST-elevation Myocardial Infarction is consistently associated with a strong relative reduction in 30-day mortality, and is considered the first choice reperfusion strategy whenever feasible.

American Heart Journal.  2011;161(3):500-507

July 03, 2011

The overall rate of HIV transmission through percutaneous inoculation (i.e., by means of a needle or other instrument that pierces the skin) is widely reported to be 0.3%.

NEJM, October 29, 2009, pg. 1768

July 02, 2011

In a prospective case series of 728 adult emergency department patients undergoing procedural sedation-a single syringe of 1:1 ketamine-propofol provided effective sedation and analgesia with short recovery times and few adverse events.

Acad. Emerg. Med. 2011; 18:237-245

July 01, 2011

Unilateral headache, focal cerebral ischemic symptoms, and partial Horner syndrome is the classic presentation of internal carotid artery dissection.

Journal of Emerg Med. September 15, 2008.