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American Academy of Emergency Medicine

Fact of the Day - August 2011

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

August 31, 2011

Salicylate-induced pulmonary edema (SIPE) should be considered in patients who present with pulmonary edema and neurological changes, anion-gap metabolic acidosis, or possible sepsis.

South Med J.  2011;104(3):225-232

August 30, 2011

Myoclonus in patients receiving etomidate usually lasts for less than 1 minute despite its dramatic presentation which can resemble seizure activity.

als of EM, Vol. 45, pg. 184

August 29, 2011

A randomized, placebo-controlled, double-blind trial at 146 centers in 9 European countries failed to demonstrate any benefit of lowering blood pressure in acute stroke and in fact showed a trend toward harm.

AccessMedicine from McGraw-Hill   ©  2011

August 28, 2011

If rtPA is to be used for a PE, a single dose of 100 mg over 2 hours followed by unfractionated heparin is suggested.

Journal of Emerg Med. June 2009

August 27, 2011

Approximately 33% of children experience rupture of their appendix prior to operative treatment.

AMA,298 (4):438-451

August 26, 2011

The most commonly reported adverse effects of IV acetylcysteine are anaphylactoid reactions (rash, pruritus, angioedema, bronchospasm, and hypotension) which occur in about 15% of patients within 2 hours after the initial infusion.

NEJM;359(3):285

August 25, 2011

The fluorescence of urine under ultraviolet light may aid in the early identification of ethylene glycol poisoning.

NEJM;Vol. 356:611

August 24, 2011

AAEM Oral Board Review Course,Las Vegas

August 23, 2011

With primary PCI the success rate is higher than 90%, whereas current fibrinolytic therapy leads to full reperfusion in only 50 to 55% of  patients with ST-segment elevation  myocardial infarction.

NEJM, June 25, 2009, pg. 2779

August 22, 2011

Troponin elevation can be detected as early as 2-4 hours after the onset of symptoms but may be delayed for 8-12 hours. After MI, the increased level may persist for 5 to 14 days.

als of EM, Vol. 51., pg. 591

August 21, 2011

PURSUIT Risk Factors For Acute Myocardial Infarction• Age• Gender• Highest Canadian Cardiovascular Society angina classification inprevious 6 weeks• Heart rate• Systolic blood pressure• Signs of heart failure (eg, rales)• ST depression on presenting electrocardiogram

August 20, 2011

Initial treatment of symptomatic carotid artery dissection is unfractionated heparin, used to prevent thrombus formation on the injured endothelial surface and thereby prevent embolization.

Mayo Clin Proc, Vol. 81, pg. 1394

August 19, 2011

Tetanus is defined by the acute onset of hypertonia or by painful muscular contractions (usually of the muscles of the jaw & neck) and generalized muscle spasms without other apparent medical cause.

Journal of Emerg Med. Vol. 32, pg. 267

August 18, 2011

The Brugada syndrome is estimated to be responsible for 4% of all sudden deaths and up to 20% of deaths in patients with structurally normal hearts.

als of Int. Med, Vol. 148, pg. 82

August 17, 2011

Hypoglycemia results in a focal neurological deficit by hypoglycemic-mediated vasospasm, structural narrowing of selective cerebral vessels thus resulting in more pronounced localized effects of hypoglycemia, and vulnerability of selective neurons .

Am J EM, Vol. 23, pg.823

August 16, 2011

Studies demonstrate that more than 85% of patients with a self-reported history of penicillin allergy have negative penicillin skin test results.

als of EM, July 2009, pg. 73

August 15, 2011

Thyroid storm is a life threatening condition whose features include fever, tachycardia out of proportion to the fever, confusion, agitation, nausea and vomiting, hypertension, congestive cardiac failure, increased alanine transaminase, alkaline phosphatase and bilirubin, with biochemical evidence of thyrotoxicosis.

August 14, 2011

A recent study of 985 febrile children under age 2 years found that the sensitivity of a urinalysis for predicting a positive urine culture result was only 64% (the specificity was 91%).

Am J Emerg Med 2009;27:930-2.

August 13, 2011

Misplacement of the catheter tip in the ipsilateral internal jugular vein instead of the SVC is a common complication of subclavian central venous catheter placement - it occurs in approximately 5% of patients.

NEJM. 2008;358:1758-9.

August 12, 2011

A retrospective study of 1684 patients with acute MI found that 12% of those presenting to the ED had ECG findings indicative of ischemia that were missed by emergency clinicians.

EBMedicine.net .January 2010.

August 11, 2011

1/2 - 1/3 of patients with acute-onset AF will experience spontaneous conversion to NSR within 24 hours.

Mayo Clin Proc 2009;84:643-62.

August 10, 2011

The best available evidence, though limited, suggests that the Epley maneuver appears to be most likely to result in symptomatic relief  in patients with benign positional vertigo and should be considered first line treatment.

Cochrane Database of Systematic Reviews, Issue 3, 2009

August 09, 2011

The acute retroviral syndrome - acute primary HIV infection - is characterized by nonspecific symptoms that is often misdiagnosed as a common viral illness with Aseptic meningitis being reported in 24% of cases of acute HIV infection.

NEJM. 2009;360:1540-1548

August 08, 2011

Fascicular VT occurs in hemodynamically stable young patients without any underlying ischemic heart disease with ECG showing a right bundle-branch block pattern and left-axis deviation with a relatively narrow QRS complex (100-140 msec).

Am J Emerg Med  2007; 25: 572-575.

August 07, 2011

In the International Registry of Aortic Dissection study, syncope occurred in more than 12% of patients with type A dissection and 2.2% of these patients did not have pain or other neurological findings.

JAMA 2000;283:897-903.

August 06, 2011

Staphylococci (S. aureus and coagulase-negative staphylococcus species) account for more than half of cases of prosthetic-hip and prosthetic-knee infection.

NEJM. Volume 361:787-794 August 20, 2009

August 05, 2011

The 2008 American College of Chest Physicians guidelines recommend catheter-directed pharmacothrombolysis, mechanical thrombectomy, and stent placement or surgical thrombectomy in patients with ilio-femoral DVT.

Chest. 2008;133:454S-545S

August 04, 2011

Blue toe syndrome refers to acute digital ischemia caused by athero-microembolism and is associated with cool, painful cyanotic toes in the presence of palpable distal pulses.

Rosen's Emergency Medicine: Concepts and Clinical Practice, 6th. Ed. © C.V. Mosby

August 03, 2011

CT and MRI studies have undermined the concept of cricoid pressure and have demonstrated that cricoid pressure commonly causes esophageal displacement instead of occlusion.

als of EM Vol. 47:548

August 02, 2011

Codeine is a prodrug that exerts its analgesic effects after metabolism to morphine.

Mayo Clin Proc, July 2009, pg. 613

August 01, 2011

Baker's cysts may be seen in patients with rheumatoid arthritis, in whom they consist of a synovium-lined sac that is continuous with the joint space. Symptoms of a Baker's cyst, especially if it ruptures, may mimic those of venous thrombosis.

NEJM. Volume 361:1098. September 10, 2009