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American Academy of Emergency Medicine

Fact of the Day - October 2011

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

October 31, 2011

The upper limits of the QT interval corrected for the heart rate (the QTc) are < 460 msec for women and < 440 msec for men.

NEJM, January 10, 2008

October 30, 2011

Nitrates should not to be given to patients who have taken a phosphodiesterase inhibitor for erectile dysfunction 24 hrs previously or within 48 hrs of taking sildenafil.

Am J EM, January 2008, pg. 91

October 29, 2011

Thrombocytopenia is an independent predictor of multiple organ failure and poor outcome in patients with severe sepsis.

als of EM, Vol. 48, pg. 54

October 28, 2011

Most survivors of adult cardiac arrest have an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and these patients are best treated initially with chest compressions and early defibrillation rather than airway management.

Circulation. 2010;122:S640-S656.

October 27, 2011

Mitral-valve prolapsed is the most frequent underlying cardiac abnormality in cases of infective endocarditis.

NEJM, December 4, 2008, pg. 2481

October 26, 2011

ELISA D-dimer testing is highly sensitive (96.4-100%) for the diagnosis of PE.

Journal of Emerg Med., November 2008, pg. 376

October 25, 2011

Kawasaki disease is the leading cause of acquired heart disease in children.

Journal of Emerg Med., November 2008, pg. 429

October 24, 2011

Chocolate-brown blood and cyanosis in the setting of a normal paO2 are both strongly suggestive of methemoglobinemia.

Journal of Emerg Med., November 2008, pg. 447

October 23, 2011

In the acute setting, (ED) the addition of Non-Invasive Ventilation to standard care reduces the rate of endotracheal intubation (absolute risk reduction of 23%, 95% confidence interval: 10%-35%), ICU length of stay (absolute reduction of 2 days, 95% confidence interval: 1-3 days), and ICU mortality (absolute risk reduction of 17%, 95% confidence interval: 8%-26%).

Emerg Med Clin N Am 26 (2008) 929-939

October 22, 2011

The most common cause of death after bariatric surgery is peritonitis from an anastomotic breakdown that is typically diagnosed within 10 days after surgery.

Journal of Emerg Med., January 2008, pg. 13

October 21, 2011

Patients receiving massive blood transfusion may develop citrate toxicity which results in hypocalcemia and hypomagnesemia.

Journal of Emerg Med., July, 2007, pg. 56.

October 20, 2011

In some patients with WPW, intravenous verapamil can increase the ventricular response to atrial fibrillation and has resulted in ventricular fibrillation.

Am J EM,Vol. 25, pg. 459

October 19, 2011

Cardiotocographic monitoring is recommended for a minimum of 4 hours duration for pregnant patients of greater than 24 weeks gestation who present to the ED with blunt abdominal trauma.

Emerg Med Clin of NA, Vol. 21, pg. 623

October 18, 2011

When performing an LP, not reinserting the stylet before removing the spinal needle is associated with a higher risk of subsequent headache.

JAMA, Vol.;296:2012

October 17, 2011

A major change in basic life support is a step away from the traditional approach of airway-breathing-chest compressions (taught with the mnemonic "A-B-C") to first establishing good chest compressions ("C-A-B").

Circulation. 2010;122:S640-S656

October 16, 2011

Currently, only 3 therapies have emerged as truly beneficial in terms of meaningful outcomes in the treatment of primary cardiac arrest: rapid defibrillation, good chest compressions (with less emphasis on early airway interventions and minimizing interruptions), and induced hypothermia.

Medscape Emergency Medicine, December 2009.

October 15, 2011

Barrett's esophagus is a premalignant lesion detected in the majority of patients with esophageal and gastroesophageal adenocarcinoma - cancers that are associated with a low rate of survival (5-year survival rate, 15 to 20%).

NEJM Volume 361:2548-2556, 2009

October 14, 2011

Due to inadequate sensitivity, negative non-invasive cardiac stress tests should not be used to rule out CAD as patients with negative stress tests are just as likely to have CAD as patients with inconclusive stress tests.

Western J Emerg. Med.  2010;11(4):384-388

October 13, 2011

If a patient with acute severe salicylate intoxication requires intubation, the goal should be to maintain the pCO2 at pre-intubation levels, or possibly even lower if CNS depression was already evident.

Goldfrank’s Toxicologic Emergencies, © 2008, McGraw-Hill..

October 12, 2011

The CAPTIM trial suggested a survival benefit of prehospital fibrinolysis (FL) compared to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) with a presentation delay of <2 hours.

Eur Heart J 2009;30:1598-606.

October 11, 2011

Studies involving repeated CT scanning of TBI patients have found that intracranial blood can develop or expand in the 48 hours after injury.

BMC Emergency Medicine 2009, 9:15

October 10, 2011

Despite improvements in CT imaging, the miss rate for blunt intestinal injuries has been reported to be around 10% based on the initial CT scan, with an associated mortality as high as 40%.

Emerg Med Clin N Am 28 (2010) 1-27

October 09, 2011

The reported incidence of missed injuries (or delayed diagnoses) in trauma patients varies from 2% to 3% to more than 60%.

Emerg Med Clin N Am 28 (2010) 1-27

October 08, 2011

B-blockers and calcium cha

Emerg Med Clin N Am 28 (2010) 1-27

October 07, 2011

Massive transfusion protocol (MTP) is defined as using packed red blood cells (PRBCs), fresh frozen plasma, and platelet packs in the ratio of 1:1:1 for patients receiving more than 10 units of PRBCs in the first 6 hours.

Am J Surg 2009;197(5): 565-70.

October 06, 2011

Unrecognized pre-hospital esophageal intubations remain a common problem in trauma airway management and occurs at reported rates ranging from 0.5% to more than 6%.

Emerg Med Clin N Am 28 (2010) 1-27.

October 05, 2011

The most recent ACC/AHA guidelines recommend the use of oral b-blockers for NSTE-ACS patients without contraindications only within the first 24 hours of arrival in the ED.

EBMedicine.net. January 2010.

October 04, 2011

In-hospital cardiac arrests have slightly better outcomes than those that occur outside the hospital, with restoration of circulation in 44% of patients and survival to discharge in 17% of patients.

NEJM . Volume 361:605-611 August 6, 2009

October 03, 2011

In the Clopidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) of patients at high risk for ST-segment elevation, the use of IV b-blockers caused significantly greater cardiogenic shock than the use of placebo (p < 0.00001).

EBMedicine.net .January 2010.

October 02, 2011

N-acetylcysteine prevents hepatic injury primarily by restoring hepatic glutathione, which binds to NAPQI to form nontoxic metabolites.

Clin Toxicol (Phila) 2008;46(10):927-1057.

October 01, 2011

A retrospective cohort study of Five hundred and fifty-seven children treated with Aminoglycosides for = 5 days demonstrated the rates of Acute Kidney Injury of 33%.

Nephrol Dial Transplant.  2011;26(1):144-150