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American Academy of Emergency Medicine

Fact of the Day - November 2011

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

November 30, 2011

A principal feature of COPD is a limitation of airflow that is not fully reversible and is associated with an abnormal inflammatory response in the small airways and alveoli.

NEJM .Volume 360:2445-2454 June 4, 2009

November 29, 2011

Studies have indicated that the presence of simultaneous ST-segment elevation (STE) in leads aVR and aVL or the presence of STE in aVR that exceeds the amount of STE in lead V1 is highly specific for LMCA occlusion in patients with ACS.

Am J Emerg Med. 2006;24:864-874.

November 28, 2011

In the CRUSADE database, an observational registry of more than 57,000 NSTE-ACS patients, those receiving morphine had an increased likelihood of death compared with those who did not receive the medication.

EBMedicine.net. January 2010.

November 27, 2011

In patients with subarachnoid hemorrhage, Higher Hunt-Hess grade, female gender, larger body surface area, larger left ventricular mass, lower systolic blood pressure, and higher heart rate are all predictors of troponin elevations.

Am J Emerg Med. 2008;26:331-341

November 26, 2011

Large pulmonary emboluses induce acute right ventricular pressure overload, which causes increased wall tension and regional wall ischemia and leads to elevated troponin levels.

Am J Emerg Med. 2008;26:331-341

November 25, 2011

Troponin elevations in sepsis patients predict increased severity of sepsis, prolonged intensive care unit length of stay, and increased mortality.

Am J Emerg Med. 2008;26:331-341

November 24, 2011

Severe tachycardia, even in the presence of normal coronary arteries, can induce elevations of troponins due to increased myocardial oxygen demand and decreased myocardial oxygen supply.

Am J Emerg Med. 2008;26:331-341

November 23, 2011

Patients with troponin elevations after blunt cardiac trauma have a higher risk of cardiac dysrhythmias and LV dysfunction.

Am J Emerg Med. 2008;26:331-341

November 22, 2011

Troponin elevations are often associated with the presence of dilated cardiomyopathy, peripartum cardiomyopathy, chemotherapy-induced cardiomyopathy, and Takotsubo cardiomyopathy (a type of cardiomyopathy associated with severe emotional stress).

Am J Emerg Med. 2008;26:331-341

November 21, 2011

Hydromorphone is a synthetic derivative of morphine with a longer duration of action (4 to 6 hours) and elimination half-life (3 to 4 hours). Hydromorphone is approximately 10 times more lipophilic than morphine and 5 times more potent.

Anesthesiology Clin 27 (2009) 241-268

November 20, 2011

The randomized, double-blinded study of 289 ED patients taking metoclopramide showed that administration of diphenhydramine did not decrease the rate of akathisia.

als of Emerg Med. March 2009;53(3):379-385.

November 19, 2011

Using a cutoff of a 50% coronary lesion, the diagnostic accuracy of coronary CTA has a sensitivity of 100% and specificity of 91.5%.

als of Emerg Med. March 2009;53(3):295-304.

November 18, 2011

B-Lines (vertical "comet tail" artifacts) are sonographic signs of lung edema (interstitial/alveolar) and/or fluid filled lung findings commonly found in CHF.

Acad Emerg Med. March 2009;16(3):201-210

November 17, 2011

Patients with COPD exacerbations that were admitted to the hospital have a high prevalence of pulmonary embolism up to 25.5%.

Chest 135(3):786-93

November 16, 2011

For symptomatic or unstable bradydysrhythmias, intravenous infusion of chronotropic agents (eg, dopamine, epinephrine) is recommended as an equally effective alternative therapy to transcutaneous pacing when atropine fails.

Circulation. 2010;122:S640-S656

November 15, 2011

The ARDSnet group in a large randomized controlled trial that demonstrated no difference in outcome between patients with acute lung injury ventilated with a lower level of PEEP (8 cm H2O) and those ventilated with a higher level of PEEP (14 cm H2O).

Cont Edu Anaesth Crit Care & Pain. 2009;9(5):152-156

November 14, 2011

The ARDSnet tidal volume study showed a significant reduction in mortality by utilizing a low-volume ventilatory strategy based on predicted body weight (6 ml kg and peak pressures < 30 cm H2O vs 12 ml kg and peak pressures < 50 cm H2O.

Cont Edu Anaesth Crit Care & Pain. 2009;9(5):152-156

November 13, 2011

Ventilator-induced lung injury encompasses the tetrad of barotrauma, volutrauma, atelectrauma, and biotrauma.

Cont Edu Anaesth Crit Care & Pain. 2009;9(5):152-156

November 12, 2011

Acute Lung Inury (ALI) is a condition that is diagnosed clinically and radiologically based on the presence of non-cardiogenic pulmonary edema and respiratory failure in a critically ill patient.

Cont Edu Anaesth Crit Care & Pain. 2009;9(5):152-156

November 11, 2011

Empiric gram negative coverage for the Central-Venous Catheter-Related Bloodstream Infections is usually a third or fourth generation cephalosporin, carbapenem, or ß-lactam/ß-lactamase combination.

Pediatr Infect Dis J. 2009;28(11):1016-1017

November 10, 2011

To diagnose the Central-Venous Catheter-Related Bloodstream Infections with CVC in situ, most experts recommend comparative blood cultures obtained via the CVC and a peripheral vein prior to initiating antibiotics.

Pediatr Infect Dis J. 2009;28(11):1016-1017

November 09, 2011

Opiates are classified as agonists, partial agonists, agonist-antagonists, and antagonists. Examples of the m1 agonists include morphine, hydromorphone, methadone, fentanyl, sufentanil, remifentanil, codeine, oxycodone, and hydrocodone.

Anesthesiology Clin 27 (2009) 241-268

November 08, 2011

Transvaginal ultrasound can identify an intrauterine pregnancy at about 5 weeks' gestational age (3 weeks post-conception), about 7-10 days earlier than trans-abdominal ultrasound.

Emergency Ultrasound;2008, p 295

November 07, 2011

Rocky Mountain Spotted Fever symptoms typically develop 5-7 days and include nonspecific abdominal pain followed by development of a maculopapular, erythematous, non-pruritic rash with distal-to-proximal progression. Mayo Clin Proc, January 2008, pg. 94

November 06, 2011

The earliest EKG manifestations are most characteristic of pericarditis and are characterized by diffuse ST-segment elevation (almost always observed in V4-V6 and lead II) with reciprocal changes in aVR and V1.

Journal of Emerg Med., September 9, 2008

November 05, 2011

Cerebral ischemic symptoms in the settings of an internal carotid artery dissection are usually due to emboli, originating from the dissection.

Journal of Emerg Med. September 15, 2008

November 04, 2011

Up to 44% of patients with blunt aortic injury may have a normal mediastinum on CXR.

NEJM, October 16, 2008, pg. 1708

November 03, 2011

Tumor lysis syndrome results in hyperuricemia, hyperphosphatemia, hypocalcemia, and hyperkalemia.

Journal of Emerg Med., December 10, 2007

November 02, 2011

A spinal epidural abscess can injure the spinal cord indirectly as a result of vascular occlusion caused by septic thrombophlebitis and directly by compressing the cord.

NEJM, Vol. 355, pg. 2013

November 01, 2011

A meta-analysis of short-term stroke risk indicated that ED patients have higher post-TIA stroke rates than other populations: 3.1% at 2 days and 5.8% at 7 days.

als of Emerg Med, November 10, 2008