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American Academy of Emergency Medicine

Fact of the Day - January 2012

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

January 31, 2012

Three-in-one Femoral Nerve Blocks provide rapid, effective pain relief and have also been shown to decrease the opioid and volume of local anesthetic requirement for pain management.

Western J Emerg Med. 2010;11(4):310-313

January 30, 2012

Review demonstrated that of 1414 adult patients with non-traumatic arrest (613 with ventricular fibrillation (VF)/ventricular tachycardia (VT) and 742 with other rhythms), 86% underwent pre-hospital intubation and survival to hospital discharge did not differ significantly between intubated and non-intubated patients (6.5% vs. 10.0%).

Prehosp Emerg Care 2011 Jan; 15:44.

January 29, 2012

A retrospective cohort study of 776,734 trauma patients demonstrated that patients receiving pre-hospital IV fluids were significantly more likely to die, especially patients with penetrating mechanism , severe head injury), and patients undergoing immediate surgery.

Annals of Surgery. 2011;253(2):371-377

January 28, 2012

The life-threatening DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is characterized by the presence of at least three of the following findings: fever, exanthema, eosinophilia, atypical circulating lymphocytes, lymphadenopathy, and hepatitis.

Pharmacotherapy. 2011;31(3):45e-49e

January 27, 2012

In ED patients with symptomatic atrial fibrillation, increased age, inadequate ED ventricular rate control, dyspnea, smoking, and B-blocker treatment were associated with an increased risk of a 30-day adverse events.

Emerg Med. 2011;57:1-12

January 26, 2012

Results from the CLUE study, a head-to-head comparison between Ready-to-Use Cardene ® IV (nicardipine) and labetalol in the emergency room, showed that Ready-to-Use Cardene IV. lowers acutely elevated blood pressure more effectively than labetalol.

Ann. Emerg. Med. 2010;56(3):S34-S35.

January 25, 2012

For patients with either NSTEMI or STEMI Intravenous unfractionated heparin (UFH) should be dosed by weight with a bolus dose of 60 U/kg to a maximum of 4000 U and an infusion dose of 12 U/kg/h to a maximum of 1000 U/h.

Cardiosource (C)2009 American College of Cardiology, December 2, 2009

January 24, 2012

Decision Rules for Avoiding CT in Children With Head Trauma

< 2 Years 2 Years
Normal mental status Normal mental status
No scalp hematoma except frontal No loss of consciousness
Loss of consciousness for < 5 seconds No vomiting
Nonsevere injury mechanism* Nonsevere injury mechanism*
No palpable skull fracture No signs of basilar skull fracture
Normal behavior No severe headache

Kuppermann N et al. Lancet September 15, 2009

January 23, 2012

Asthmatic Patients with altered mental status (a sign of hypoxia or hypercapnia), exhaustion (often manifest as worsening diaphoresis, tachycardia, or retractions), or worsening hypercapnia (on arterial blood gas or end-tidal CO2 monitoring) should be strongly considered for intubation and mechanical ventilation with acceptable permissive hypercapnia.

N Engl J Med. 2010;363:755-764

January 22, 2012

Acute lung injury 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

January 21, 2012

Whole-body hypothermia is categorized as moderate when the goal temperature is between 32 and 33 °C. This level of hypothermia has been demonstrated to be neuroprotective for adults with cardiac arrest and neonates with perinatal asphyxia.

Pediatric Health. 2009;3(6):533-541

January 20, 2012

Between 100,000 and 150,000 children suffer from severe TBI and approximately 10-15% result in death or severe disability every year.

Pediatric Health 2009;3(6):533-541

January 19, 2012

S. aureus is the most common organism implicated in cases of septic arthritis in the adult population, representing up to 50% in large studies, while Gonococcal arthritis has decreased in prevalence.

Medscape Infectious Disease, September 25, 2009.

January 18, 2012

Chest computed tomography angiograms (CTAs) to evaluate patients for acute pulmonary embolism in the emergency department are more than twice as likely to find an incidental pulmonary nodule or adenopathy as they are to find a pulmonary embolism

Arch Intern Med. 2009;169(21)

January 17, 2012

In hypertensive crisis with renal dysfunction, nicardipine treated patients are more likely to reach a target BP range within 30 minutes than patients receiving labetalol.

Chest. 2010; 138:906A

January 16, 2012

Physical examination factors of patients with asthma that associated with an increased risk for death include altered mental status, paradoxical chest or abdominal movement, or absence of wheezing.

N Engl J Med. 2010;363:755-764

January 15, 2012

The following groups should receive the annual influenza vaccine as soon as it becomes available:
  • Pregnant women
  • People who live with or care for infants younger than 6 months of age
  • Healthcare workers (HCWs) and emergency medical personnel
  • Persons 6 months to 24 years of age
  • Persons 25-64 years of age who have chronic diseases (including immunodeficiency states) that pose risk for influenza

Medscape Infectious disease. September 25,2009

January 14, 2012

In patients with STEMI, markedly increased BNP level seems to reflect the extent of coronary disease, the degree of associated systolic and diastolic dysfunction, and a higher risk of in-hospital mortality.

American Journal of Emergency Medicine (2011) 29, 141-147

January 13, 2012

In SAH, re-bleeding occurs in 4% of patients in the first 24 hours after hemorrhage, and approximately 1.5% per day for up to 2 weeks after the initial hemorrhage, yielding a total re-hemorrhage rate of 26.5% over the first 2 weeks after the INITIAL BLEED.

Journal of Emerg Med. 2008;34(3):237-251

January 12, 2012

Numerous studies over several decades document that misdiagnosis of SAH occurs approximately 25% of the time (12–50%), even in the era of ready access to cranial computed tomography (CT) scanning.

Journal of Emerg Med. 2008;34(3):237-251.

January 11, 2012

Approximately 3% of radiographs interpreted by EPs are subsequently given a discrepant interpretation by the radiology attending. The most commonly missed findings included fractures, dislocations, air-space disease, and pulmonary nodules.

Journal of Emergency Medicine (2011) 29, 18-25

January 10, 2012

The presence of lethargy, grunting, and a PaCO2 of 65 mm Hg or greater at initial presentation in the ED were predictive for the subsequent need for mechanical ventilation in previouslyhealthy, RSV-infected children admitted to the PICU.

American Journal of Emergency Medicine (2011) 29, 168-173

January 09, 2012

The ECG findings in Brugada Syndrome consist of coved or saddleback ST elevation in the right precordial leads (V1-3) with possible resulting formation of RBBB-like pattern.

Journal of Emerg Med. 2009;37(1):15-20.

January 08, 2012

Up to 27% of individuals with diagnosed Brugada syndrome will develop ventricular tachycardia (VT) or sudden cardiac death (SCD) during a 2-3 year follow-up period.

Journal of Emerg Med. 2009;37(1):15-20.

January 07, 2012

Historical factors that have been correlated with an increased risk for death from asthma include previous intubation or intensive care unit (ICU) admission, 2 or more hospitalizations for asthma during the past year, low socioeconomic status, and coexisting illnesses.

N Engl J Med. 2010;363:755-764

January 06, 2012

The usual dose of Etomidate for RSI is 0.1-0.3 mg/kg. For procedural sedation, a dose of 0.1-0.4 mg/kg may be administered. In the pediatric studies published to date, the usual total dose for etomidate has ranged from 0.1 to 0.6 mg/kg.

Pediatr Pharm. 2008;14(9)

January 05, 2012

The PERC score provides clinicians with an easily remembered, validated clinical decision rule that allows physicians to forgo diagnostic testing for pulmonary embolus in a very low-risk population.

Journal of Emerg Med. 2009;36(3):317-322

January 04, 2012

Optimal management of cardiac arrest in the current decade can be summarized simply by "the 4 Cs": Cardiovert/defibrillate, CCR, Cooling, and Catheterization.

Medscape Emergency Medicine Viewpoint 12/30/2010

January 03, 2012

A negative D-dimer result in a patient with a low clinical probability for pulmonary embolus effectively excludes the presence of pulmonary embolus.

Am J Roentgenology,Volume 192, Issue 5, May 2009

January 02, 2012

Administration of opioids for migraine headache may result in longer ED stays when compared with non-opioid migraine treatments.

Journal of Emerg Med. 2009;36(4):333-337.

January 01, 2012

Sore throat and odynophagia in patients with acute exudative pharyngitis may respond better to treatment with an 8 mg single dose of intramuscular dexamethasone accompanied by an antibiotic regimen than to antibiotics alone.

Journal of Emerg Med. 2008;35(4):363-367.