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American Academy of Emergency Medicine

Fact of the Day - September 2011

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

September 30, 2011

Infarction of the right ventricle causes a preload dependent state; therefore, nitroglycerin should be avoided with known right ventricular infarct.

EBMedicine.net. January 2010.

September 29, 2011

End-tidal CO2 monitors should be used in all patients given sedating medications for procedural sedation or analgesia especially if medical comorbidities are present to prevent adverse outcomes.

Emerg Med Clin N Am 28 (2010) 235-256.

September 28, 2011

All antipsychotics can have cardiotoxic actions, including prolongation of the QTc interval, which predisposes to torsades de pointes and other ventricular tachyarrhythmias.

Anesthesiology 2007;107(4):531-6.

September 27, 2011

Movement disorders, tardive dyskinesias, and extrapyramidal symptoms are the most common and troubling side effects of the antipsychotics and may limit use.

Emerg Med Clin N Am 28 (2010) 235-256.

September 26, 2011

A randomized, double-blind trial with 68 patients requiring chemical adjuncts to physical restraints found that in equal doses intramuscular droperidol has more rapid control of patients than haloperidol.

Emerg Med Clin N Am 28 (2010) 235-256.

September 25, 2011

Benzodiazepines are a preferred first-line choice for the acute management of agitation caused by sedative-hypnotic drug and ethanol withdrawal, cocaine, and sympathomimetic ingestions and muscle hyperactivity.

Emerg Med Clin N Am 28 (2010) 235-256.

September 24, 2011

Patients with severe sepsis not in shock or patients with septic shock stabilized with fluid and vasopressor therapy should not receive steroid therapy.

Crit. Care Med.  2011;39(3):571-574

September 23, 2011

Reversible adrenal insufficiency has been frequently diagnosed in critically ill patients with sepsis who have either low basal cortisol levels or low cortisol responses to adrenocorticotrophic hormone (ACTH) stimulation.

Crit Care Med.  2011;39(3):571-574

September 22, 2011

Most head-injured patients do not require deep chemical restraint, but rather anxiolytics or a discrete period of procedural sedation for the purpose of diagnostic imaging and treatment.

Emerg Med Clin N Am 28 (2010) 235-256

September 21, 2011

Agitation in the form of emotional lability and angry outbursts is well described in the recovery phase of traumatic brain injury, but agitation is also one of the earliest signs of increased intracranial pressure in the acute setting.

Emerg Med Clin N Am: 28 (2010) 235-256

September 20, 2011

Excessive stimulation of muscarinic receptors produces the "SLUDGE" toxidrome: salivation, lacrimation, urination, diarrhea, gastric secretions and emesis. It also produces miosis, and the "triple Bs": bradycardia, bronchospasm and bronchorrhea.

Western J Emerg Med.  2010;11(5):524-527

September 19, 2011

Two well-designed studies demonstrate that in children between 6 months and 2 years of age with a certain diagnosis of Acute Otitis Media, the use of antibiotics result in faster recovery and less treatment failure.

N Engl J Med 2011;364(2):105-15, 116-26.

September 18, 2011

Frank hypointensity on CT, particularly if it involves more than one third of an MCA territory, is a strong contraindication to treatment with thrombolysis.

Stroke 2009;40(11):3646-78.

September 17, 2011

Acute adrenal insufficiency is a potentially life-threatening emergency that presents with shock and non-specific clinical features such as anorexia, nausea, vomiting, abdominal pain, fever and general lethargy.

Postgrad Med J 2007;83:79-86

September 16, 2011

MRI is at least equal in efficacy to CT for detection of ICH in the hyperacute stroke patient, and both appear to have very high sensitivity and specificity.

Stoke, Vol. 40, November 20, 2009, pg. 3651

September 15, 2011

Methylene chloride, a solvent found in paint remover and aerosol propellants, is converted in the body to CO after inhalational exposure and can produce CO poisoning.

EM Clin NA;22:985

September 14, 2011

80% of patients who present with pulmonary embolism have evidence of DVT in their legs.

NEJM, Vol. 358, pg. 1037

September 13, 2011

Heroin can be detected up to 48 hours following last use; Cocaine metabolites can be detected up to 2-4 days after last use.

Mayo Clin Proc, Vol. 82, pg. 66

September 12, 2011

In patients with an inferior wall MI, a higher ST-segment elevation in lead III than in lead II is a sensitive and specific marker for right coronary artery obstruction.

JEM, November 19, 2007.

September 11, 2011

Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide.

MMWR, February 6, 2009

September 10, 2011

Dystonic reactions can occur up to 36 hours after a single dose of  phenothiazine.

Journal of Emergency Medicine, Vol. 31;53

September 09, 2011

Classic Wernicke's Encephalopathy is associated with mental status changes, gait ataxia, & opthalmoplegia which present in only 10% of cases.

Journal of Emergency Medicine,   May 1, 2009

September 08, 2011

Management of an acute adrenal crisis consists of immediate IV administration of 100 mg of hydrocortisone, followed by 100 - 200 mg every 24 hours and a continuous infusion of larger volumes of physiologic saline solution.

NEJM, May 28, 2009, pg. 2328

September 07, 2011

Thrombotic occlusion of the IVC is a well-recognized complication of IVC filter placement that occurs in up to 11% of patients.

als of EM, August 2008, pg. 104

September 06, 2011

Patients treated with oral acetylcysteine should be monitored for vomiting. The dose of acetylcysteine should be repeated if the patient vomits within 60 minutes after any dose.

NEJM 2008;359:285

September 05, 2011

The use of inhaled beta-2 agonists provides improved cardiovascular hemodynamics after treatment, increased cardiac output, decreased peripheral vascular resistance, and improved pulmonary capillary wedge pressures in chronic heart failure patients

J Emerg Med.  2011;40(2):135-145.

September 04, 2011

Myxedema coma, a potentially lethal complication of hypothyroidism, is treated with levothyroxine IV. IV glucocorticoid is also recommended until adrenal insufficiency has been excluded.

Journal of Emerg Med. Vol. 28, pg. 203

September 03, 2011

The primary fetal risks associated with high-dose radiation exposure from imaging studies are growth restriction, microcephaly, and developmental disabilities with the most vulnerable period is 8-15 menstrual weeks of gestation .

MMWR, April 10, 2009

September 02, 2011

The reported prevalence of any pain among patients visiting the emergency department (ED) is as high as 78%, underlying chronic pain conditions were reported by 40% of all ED patients who presented with pain.

Western J Emerg Med.  2010;11(5):408-415

September 01, 2011

60% - 70% of AMI patients in the US present to hospitals without ready access to PCI.

als of EM, June 2009, pg. 742