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American Academy of Emergency Medicine

Fact of the Day - December 2011

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

December 31, 2011

Salter Harris incidence Type I: 6% Type II: 75% Type III: 10% Type IV: 10% Type V: 1%

Wheeless' Textbook of Orthopaedics. Copyright © 1996-2009 Data Trace Internet Publishing, LLC

December 30, 2011

The hemolytic-uremic syndrome is characterized by non-immune hemolytic anemia, thrombocytopenia, and renal impairment and occurs most frequently in children under the age of 5 years.

NEJM. 2009;361:1676-87.

December 29, 2011

In critically ill patients with acute kidney injury, treatment with higher-intensity continuous renal-replacement therapy did not reduce mortality at 90 days.

NEJM. 2009;361:1627-38.

December 28, 2011

The Norovirus Gastroenteritis normally lasts only 2 to 3 days but can last longer (i.e., 4 to 6 days) in nosocomial outbreaks and among children younger than 11 years of age.

NEJM.2009;361:1776-85.

December 27, 2011

Humans are believed to be the only host for human norovirus and fecal-oral spread is the primary mode of transmission, although infectious vomitus can play a role as well.

NEJM. 2009;361:1776-85.

December 26, 2011

Postexposure prophylaxis should be initiated as rapidly as possible after exposure to HIV, preferably within 36 hours and should be continued for 28 days.

NEJM. 2009;361:1768-75

December 25, 2011

The estimated risk of HIV transmission associated with sharing needles for injection-drug use is approximately 0.67% per needle- sharing contact.

NEJM. 2009;361:1768-75

December 24, 2011

The per-contact risk of HIV transmission from sexual exposure varies according to the nature of the exposure. The estimated risks are 1 to 30% with receptive anal intercourse, 0.1 to 10.0% with insertive anal intercourse and receptive vaginal intercourse, and 0.1 to 1.0% with insertive vaginal intercourse.

NEJM. 2009;361:1768-75

December 23, 2011

Splashes of infectious material to mucous membranes (e.g., conjunctivae or oral mucosa) or broken skin also may transmit HIV infection (estimated risk per exposure, 0.09% [95% CI, 0.006 to 0.5]).

NEJM. 2009;361:1768-75

December 22, 2011

Evidence is growing that pediatric patients of all ages, even the most extremely premature neonates, are capable of experiencing pain as a result of tissue injuries due to medical illnesses, therapeutic and diagnostic procedures, trauma, and surgery.

Anesthesiology Clin 27 (2009) 241-268

December 21, 2011

There are more than 50,000 new cases of HIV infection in the United States and 2.7 million new cases worldwide annually.

NEJM. 2009;361:1768-75.

December 20, 2011

Urinary tract infection is a very common illness in children, affecting 2% of boys and 8% of girls by the age of 7 years.

NEJM. 2009;361:1748-59.

December 19, 2011

Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children.

NEJM. 2009;361:1748-59

December 18, 2011

Out of 272 patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009, 25% were admitted to an intensive care unit and 7% died.

NEJM. 2009;361:1935-44.

December 17, 2011

Hemodynamic optimization to maintain vital organ perfusion, avoidance of hyperventilation, and maintenance of euglycemia are critical elements in post-arrest care.

Circulation. 2010;122:S640-S656.

December 16, 2011

The elderly, blacks, and patients with characteristics associated with high cardiac output (e.g., obesity) tend to have low-renin or salt-sensitive hypertension which is responding preferentially to thiazides.

NEJM. 2009;361:2153-64

December 15, 2011

Thiazide diuretics reduce blood pressure when administered as monotherapy, enhance the efficacy of other antihypertensive agents, and reduce hypertension-related morbidity and mortality.

NEJM 2009;361:2153-64

December 14, 2011

Induced hypothermia, although best studied in survivors of VF/pulseless VT arrest, is recommended for adult survivors of cardiac arrest who remain unconscious, regardless of presenting rhythm should be initiated as soon as possible after return of spontaneous circulation with a target temperature of 32 °C-34 °C

Circulation. 2010;122:S640-S656

December 13, 2011

An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects.

NEJM, Volume 361:2529-2537

December 12, 2011

ED physician-activated cath lab for patients with acute STEMI results in significant reduction in mean infarct size, hospital length of stay, and total hospital costs per admission.

Circulation. 2007;116:67-76

December 11, 2011

Cardiogenic shock caused by mechanical complications of MI (eg rupture of the ventricular septum, free wall, or papillary muscles) have the highest mortality, estimated to be > 85%.

Int J Cardiol. 2008;123:221-228

December 10, 2011

Emergent reperfusion therapy is indicated for patients with post-MI Cardiogenic shock regardless of age and is associated with increased survival.

Int J Cardiol. 2008;123:221-228

December 09, 2011

Severe left ventricular (LV) dysfunction is the most common cause of post-MI cardiogenic shock.

Circulation. 2008;117:686-697

December 08, 2011

Cardiogenic Shock is defined as a state of tissue hypoperfusion resulting from cardiac failure and manifests as systemic hypotension, peripheral vasoconstriction and diminished pulses, decreased urine output, decreased mental status, or significantly reduced cardiac indices despite correction of preload.

Circulation. 2008;117:686-697

December 07, 2011

The use of vasopressin in cardiac arrest patients appears to produce a trend toward worse neurologic outcome among survivors without improving overall survival.

N EJM. 2008;359:21-30

December 06, 2011

Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions.

NEJM Volume 360:2079-2089 May 14, 2009

December 05, 2011

Epinephrine (EPI) has long been considered a standard drug for patients in cardiac arrest, although there is no concrete evidence that EPI increases survival to hospital discharge or good neurologic outcome, regardless of dose.

Medscape Emergency Medicine, February 2, 2009

December 04, 2011

The incidence of ketamine-induced emergence reactions seems to be about 10-20%, however, this decreases with the use of other anxiolytic/sedating agents or with pre-induction counseling.

Acad Emerg Med. 2008; 15:1223-33

December 03, 2011

Atropine is no longer recommended for routine use in patients with pulseless electrical activity or asystole.

Circulation. 2010;122:S640-S656

December 02, 2011

The results of The Thrombolysis in Cardiac Arrest (TROICA) trial do not support routine administration of trombolytics to an unselected cardiac arrest population.

NEJM. 2008;359:2651-62

December 01, 2011

In a study by Kemp et al, rib fractures had the highest likelihood of abuse (71%), followed by humeral fractures (66%) after exclusion of major trauma as a cause.

BMJ 2008;337:a1518