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American Academy of Emergency Medicine

Fact of the Day - March 2012

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

March 31, 2012

4 to 6 weeks of colchicine therapy should be considered in all patients with acute pericarditis, especially in patients who have not benefited from NSAID therapy after 1 week.

Mayo Clin Proc 2010;85(6):572-93.

March 30, 2012

American College of Emergency Physicians recommends that patients with thunderclap headache undergo emergent neuroimaging followed by cerebrospinal fluid (CSF) analysis if imaging studies do not reveal a diagnosis.

Annals of Emerg Med 2008;52:407.

March 29, 2012

Ventilator-associated pneumonia is the most common life-threatening hospital-acquired infection that occurs in approximately 10 to 20% of patients who are on ventilators for longer than 48 hours and is associated with significant increases in length of hospital stay, mortality, and costs.

NEJM Volume 362:1804-1813 May 13, 2010

March 28, 2012

A positive response to analgesics and antimigraine therapy has been reported with virtually every category of secondary headache, including carotid artery dissection, carbon monoxide (CO) exposure, brain tumor, SAH, meningitis, and venous sinus thrombosis (VST).

Emerg Med Clin N Am 28 (2010) 127-147

March 27, 2012

Options for managing acute gouty attacks include the use of nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, glucocorticoids, and possibly corticotrophin.

N Engl J Med 2011; 364:443-452

March 26, 2012

Naloxone can precipitate profound withdrawal symptoms in opioid dependant patients. Symptoms of withdrawal include agitation, vomiting, diarrhea, piloerection, diaphoresis, and yawning.

Emerg Med Clin N Am 25 (2008) 715-739

March 25, 2012

Complications are less common with upper extremity deep-vein thrombosis than with lower extremity thrombosis, but include pulmonary embolism in 6% (versus 15 to 32% with lower extremity thrombosis), recurrence at 12 months in 2 to 5% (versus 10% with lower extremity thrombosis), and the post-thrombotic syndrome in 5% (versus up to 56% with lower extremity thrombosis).

N Engl J Med 2011; 364:861-869

March 24, 2012

In a normal pregnancy, an IUP should be reliably seen on transabdominal ultrasound with b-hCG levels greater than or equal to 2500 mIU/mL and on transvaginal ultrasound with b-hCG levels greater than or equal to 1500 mIU/mL.

Emerg Med Clin N Am 28 (2010) 103-118

March 23, 2012

According to the American Association of Poison Control Centers TESS, in the United States in 2008 alone, acetaminophen was responsible for more than 26,000 visits to health care facilities and approximately 74 deaths.

Emerg Med Clin N Am 28 (2010) 149-161.

March 22, 2012

The majority of SSRI overdoses cause minor effects characterized by mild to moderate serotonin toxicity and occasionally seizures in large overdoses. However, QT-interval prolongation and arrhythmias have been reported, mainly with citalopram2 and escitalopram.

Annals of Emerg Med. Volume 54 number 3, September 2009

March 21, 2012

Causes of first-trimester vaginal bleeding include implantation bleeding, spontaneous abortions (SABs), ectopic pregnancy, and lesions involving the female reproductive system and perineal area infections.

Emerg Med Clin N Am 28 (2010) 219-234

March 20, 2012

As compared with standard therapy, the use of intensive Glucose Lowering therapy for 3.7 years to target a glycated hemoglobin level below 6% reduced 5-year nonfatal myocardial infarctions but increased 5-year mortality.

N Engl J Med 2011; 364:818-828

March 19, 2012

Oral acyclovir can be given at 36 weeks pregnancy in women who have primary HSV outbreaks or are at risk for recurrent herpes.

Int J Gynaecol Obstet 2009;68(2):165-73.

March 18, 2012

In a study comparing Early versus Delayed Invasive Intervention in Acute Coronary Syndromes, results showed that early intervention did not differ greatly from delayed intervention in preventing the primary outcome, but it did reduce the rate of the composite secondary outcome of death, myocardial infarction, or refractory ischemia and was superior to delayed intervention in high-risk patients.

NEJM Volume 360:2165-2175 May 21, 2009

March 17, 2012

Benign paroxysmal positional vertigo (BPV) is a common peripheral vestibular disorder caused by otoconia (small crystals of calcium carbonate), which detach from the utricular macula and fall into one of the semicircular canals.

NEJM, June 24, 2010, Volume 362:e70

March 16, 2012

Uncommon presentation of appendicitis in children:

  • No migration of pain in greater than 50% of children
  • No anorexia in greater than 50% of children
  • No focal tenderness elicitable in greater than 50% of children
  • No demonstrable rebound tenderness in greater than 50% of children
  • Reported time course of pain less than 24 hours is common

JAMA 2007;298:438.

March 15, 2012

Approximately 50% of women with an ectopic pregnancy present with increasing hCG levels, and 50% present with decreasing levels.

NEJM 2009- Jul 23, Vol. 361, No. 4, 325 - 431, e4

March 14, 2012

The carcinoid syndrome is characterized by cutaneous flushing, diarrhea, wheezing, and cardiac valvular lesions. Episodes are often precipitated by the ingestion of alcohol and chocolates. Facial telangiectasia and cyanosis and pellagra-like skin changes may be seen in chronic cases.

N Engl J Med 2011; 364:1155-1165

March 13, 2012

A lifetime risk of cancer attributable to an abdominal and pelvic CT has been estimated to be 0.14% in infants and 0.06% in adults.

NEJM. 2007;357:2277-84

March 12, 2012

A systematic review of 23 studies of CT in suspected appendicitis found a weighted sensitivity and specificity of 93% and 98%, respectively, for noncontrast CT compared with CT with IV and oral contrast (93% and 93%) and CT with rectal contrast (97% and 97%).

AmJ Surg 2005;190:474-8.

March 11, 2012

The most common scoring system to improve clinical accuracy of the acute appendicitis is the Alvarado score, also known as the MANTRELS (Migration of pain, Anorexia, Nausea/vomiting, Tenderness in the right lower quadrant, Rebound tenderness, Elevated temperature, Leukocytosis, Shift to the left).

Annals of Emerg Med. ;15:557-64.

March 10, 2012

Randomized, controlled trials of unfractionated heparin or low-molecular-weight heparin have not been performed in patients with deep-vein thrombosis of an upper extremity; data from trials involving patients with thrombosis of a lower extremity are used to guide management.

N Engl J Med 2011; 364:861-869

March 09, 2012

An IV dose of 10 units of regular insulin given to adult patients in the setting of hyperkalemia lowers the serum potassium by about 0.6mmol/L with the onset of action within 15 minutes.

Crit Care Med, Vol. 36, pg 3248

March 08, 2012

Clinical features have very limited value for diagnosing ACS in patients with a normal or non-diagnostic ECG. Radiation of pain to the right arm increases the likelihood of ACS.

Journal of Emerg Med. 2009;26:866-870.

March 07, 2012

For children with a history of choking or a history concerning for foreign body inhalation, emergent bronchoscopy may be avoided in those who have a normal physical exam, normal radiographs, and who do not have persistent symptoms.

Pediatrics. 2009;155:276-280

March 06, 2012

The onset of the nausea is within four weeks of the last menstrual period in most patients. The problem typically peaks at approximately 9 weeks of gestation. Sixty percent of cases resolve by the end of the first trimester, and 91% by 20 weeks gestation.

N Engl J Med 2010;363:1544-1550

March 05, 2012

Can rocuronium replace succinylcholine as the paralytic of choice for RSI in the ED? For the outcomes of clinically acceptable intubation conditions and time to onset, the two agents are not statistically significantly different but succinylcholine seems to produce conditions that have higher satisfaction scores and succinylcholine remains the drug of choice for ED RSI unless there is a contraindication to its usage.

Journal of Emerg Med. 2009;37(2):183-188.

March 04, 2012

Approximately 10% of all cases of deep-vein thrombosis involve the upper extremities, resulting in an annual incidence of 0.4 to 1 case per 10,000 people and cases have become more common because of the increased use of central venous catheters and of cardiac pacemakers and defibrillators.

N Engl J Med 2011; 364:861-869

March 03, 2012

When considering the TIMI risk stratification scores, the researchers discovered that patients with STE in aVR, when compared with patients without STE in aVR, had higher death rates in the low-risk (18.5% vs 0%) and intermediate-risk groups (15.5% vs 2.6%).

Am J Emerg Med. 2008;26:408-412

March 02, 2012

Two to three percent of blunt trauma patients who undergo cervical spine imaging are diagnosed with a fracture. The second vertebra is most commonly injured, accounting for 24% of fractures; the sixth and seventh vertebrae together account for another 39% of fractures.

Emerg Med Clin N Am 28 (2010) 719-738

March 01, 2012

Cardiocerebral resuscitation consists of 3 major parts: continuous chest compressions with no early ventilations preshock and postshock(2) delayed intubation (3) early use of epinephrine (EPI)

Annals of Emerg Med. 2008;52:244-252