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American Academy of Emergency Medicine

Fact of the Day - May 2012

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

May 31, 2012

The Achilles tendon is a frequently ruptured structure, accounting for 40% of all surgically repaired tendon ruptures-yet the diagnosis is initially missed in about 25% of cases.

Emerg Med Clin N Am 28 (2010)

May 30, 2012

High-dose nitrates used in combination with low-dose furosemide appear to be the most effective regimen for the management of acute heart failure.

Annals of Emerg Med ;49(5):627-669.

May 29, 2012

Opioid analgesics for lower back pain should be considered a third-line alternative, and best used for those experiencing severe acute back pain with inadequate control with non-narcotic analgesics.

Emerg Med Clin N Am 28 (2010) 811-839

May 28, 2012

Nearly 30% of high-velocity knee dislocations will have associated life-threatening injuries and up to 60% of patients will have an associated fracture and 41% will have multiple fractures present.

Emerg Med Clin N Am 28 (2010) 969-996

May 27, 2012

Several echo findings make the diagnosis of cardiac tamponade with near certainty when the pretest probability is high: right atrial systolic collapse, right ventricular diastolic collapse, IVC plethora, and exaggeration of respirophasic changes in flow velocities across the tricuspid and mitral valves.

JAMA;297(16):1810-1818.

May 26, 2012

Perilunate and lunate dislocations result from similar hyperextension mechanisms,with perilunate dislocations being more common and lunate dislocations being more severe.

Emerg Med Clin N Am 28 (2010) 969-996

May 25, 2012

Among patients with cardiac tamponade, a minority will not have dyspnea, tachycardia, elevated jugular venous pressure, or cardiomegaly on chest radiograph.

JAMA;297(16):1810-1818.

May 24, 2012

In most situations, administration of fibrinolytic therapy within 30 minutes after arrival for patients without contraindications is recommended when door to balloon times > 90 minutes are anticipated with primary PCI.

NEJM. October ;357(16):1631-1638.

May 23, 2012

The dose of phenytoin is 20 mg/kg in a non-glucose solution, with a second dose of 10 mg/kg given if needed. The infusion rate is limited to 50 mg/min (25 mg/min in the elderly and patients with cardiovascular disease), as hypotension may occur primarily due to the propylene glycol diluents.

Emerg Med Clin N Am 29 (2011) 51-64

May 22, 2012

A lumbar puncture (LP) is indicated in the work-up of first-time seizure in cases of suspected central nervous system (CNS) infection or suspected subarachnoid hemorrhage.

Emerg Med Clin N Am 29 (2011) 41-49

May 21, 2012

After a first-time febrile seizure, parents should be informed that the overall risk for a second febrile seizure before the sixth birthday is approximately 32%.

Emerg Med Clin N Am 29 (2011) 803-93

May 20, 2012

The Galeazzi pattern of injuryconsists of a radius fracture, most often at the junction of the middle and distal thirdof the bone, accompanied by a dislocation at the distal radioulnar joint.

Emerg Med Clin N Am 28 (2010) 969-996

May 19, 2012

Etiologies involved in possible prolongation of the QT interval include congenital long QT syndrome, mitral valve prolapse, hypokalemia, hypocalcemia, hypomagnesemia, hypothermia, myocardial ischemia, neurologic catastrophes, and hypothyroidism.

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

May 18, 2012

Risk factors for patients presenting with syncope that are associated with clinically significant cardiac arrhythmias or death within 1 year: age > 45 years, abnormal ECG, history of CHF, history of ventricular arrhythmias.

Journal of Emerg Med ;33(1):53-60.

May 17, 2012

The Monteggia pattern of injury consists of a fracture to the proximal third of the ulna with a concomitant dislocation of the radial head.

Emerg Med Clin N Am 28 (2010) 969-996

May 16, 2012

Ottawa ankle rule: X-rays are only required if there is bony pain in the malleolar zone and any one of the following:

Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus;

Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus;

An inability to bear weight both immediately and in the emergency department for four steps.

JAMA;269:1127-1132

May 15, 2012

According to the ACC/AHA guidelines, transient ST-segment changes (= 0.05 mV) that occur with chest pain and resolve when pain resolves are the ECG finding most predictive of ACS.

EBMedicine.net. January 2010.

May 14, 2012

Patients with prolonged QT intervals, polymorphic VPCs, or ventricular bigeminy on their ECG may develop longer runs and degenerate to VF and these patients should always be carefully monitored in telemetry units.

Journal of Emerg Med ;33(1):53-60.

May 13, 2012

Mobitz type I 2nd-degree AV block is often associated with inferior MI, sclerodegenerative disease, myocarditis, and heightened venous tone (e.g., trained athletes, vomiting patients), and may be reversible. Mobitz type II AV block typically indicates some structural damage to the conduction system.

Journal of Emerg Med ;33(1):53-60.

May 12, 2012

Common factors associated with a delayed diagnosis of posterior shoulder dislocation include a late presentation by the patient, inadequate radiologic investigation, elderly patients, and those presenting with multiple injuries.

Emerg Med Clin N Am 28 (2010) 969-996

May 11, 2012

Early ICD complications are typically procedure related, whereas generator (6%) or lead (12%) complications and inappropriate shocks (12-16%) may develop at any time.

Journal of Emerg Med;33(1):53-60.

May 10, 2012

Two decision rules guide the use of cervical spine radiography in patients with trauma: the NEXUS Low Risk Criteria (NLC) and the Canadian C-Spine Rule (CCR).

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

May 09, 2012

High-dose insulin euglycemic therapy (HIET) in acute Calcium Channel Blockers Overdose consists of the infusion of high-dose regular insulin as a bolus of 1 IU/kg followed by an infusion of 0.5 IU/kg per hour, along with the administration of supplemental glucose to maintain euglycemia.

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

May 08, 2012

The RUSH (Rapid Ultrasound in Shock) shock ultrasound protocol focuses on 3 step approach: The pump, The tank, The Pipes.

Emerg Med Clin N Am 28 (2010) 29-56

May 07, 2012

Central cord syndrome, induced by damage to the corticospinal tract, is characterizedby weakness in the upper extremities, more so than in the lower extremities.

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

May 06, 2012

About half of the cases of postpartum eclampsia occur within 48 hours after delivery, and the remainder occur between 2 days and 4 weeks after delivery.

NEJM, March 12, 2009.Volume 360:1126-1137

May 05, 2012

Occult UTIs occur in 10% of febrile girls and uncircumcised boys younger than 1 year and in 5% of girls between 1 and 2 years.

Emerg Med Clin N Am 28 (2010) 67-84

May 04, 2012

Findings suggestive of lower airway aspirated foreign bodies in children include air trapping leading to asymmetric hyperinflation (38%-63%), pulmonary consolidation (8%-25%), or barotrauma (7%).

Advanced pediatric life support. 4th edition. Blackwell Publishing.

May 03, 2012

Brown-Sequard syndrome is characterized by paralysis, loss of vibration sensation,and proprioception ipsilaterally, with contralateral loss of pain and temperature sensation.

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

May 02, 2012

Approximately 50% of hemodialysis catheters fail within 1 year; up to two thirds of these failures are due to thrombosis.

N Engl J Med 2011; 364:303-312

May 01, 2012

Approximately 80% of femur fractures in children younger than 2 years are associated with abuse and a humeral diaphysis fracture before 3 years of age represents non-accidental trauma until proven otherwise.

Emerg Med Clin N Am 28 (2010) 85-102.