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American Academy of Emergency Medicine

Fact of the Day - June 2012

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

June 30, 2012

Following administration of thrombolysis for STEMI, findings suggestive of reperfusion include relief of symptoms and reduction of 50% in the initial ST-segment elevation on a follow-up ECG 60 - 90 minutes after the initiation of therapy.

Mayo Clin Proc, November 2009, pg. 1021

June 29, 2012

Post-infectious glomerulonephritis is most commonly preceded by symptoms of either pharyngitis or impetigo, with a latent period from infection to hematuria of 10 and 21 days, respectively.

Mayo Clin Proc, January 2009, pg. 72

June 28, 2012

The most frequent finding in cauda equina syndrome is urinary retention (90% sensitivity). In patients without urinary retention, the probability of cauda equina syndrome is approximately 1 in 10,000.

of Int Med, Vol. 147:478

June 27, 2012

Optic neuritis is a clinical diagnosis that often includes eye pain, a relatively abrupt vision and color differentiation loss, and an afferent pupillary defect.

AJEM, Vol. 25:834

June 26, 2012

The extent of plaque rupture is the critical factor determining whether the clinical presentation of acute coronary ischemia is silent or results in UA, NSTEMI, or STEMI.

AJEM, Vol. 26, pg. 212

June 25, 2012

Current guidelines recommend treating patients with new or presumably new left bundle branch block (LBBB) in the presence of symptoms consistent with myocardial ischemia as STE-ACS patients.

EBMedicine.net . January 2010.

June 24, 2012

Carbon monoxide poisoning is common, resulting in more than 50,000 emergency department visits per year in the United States. Sources of carbon monoxide include faulty furnaces, inadequate ventilation of heating sources, and engine exhaust.

NEJM 2009;360:1217-25.

June 23, 2012

Risk factors for development of hydatidiform moles include the extremes of maternal age and previous molar pregnancy. The hCG levels are markedly elevated, and can result in hyperemesis, hyperthyroidism, theca lutein ovarian cysts, and preeclampsia.

Journal of Emerg Med, October 5, 2009.

June 22, 2012

The visual deficits from methanol poisoning are most often reversible if they are treated early with fomepizole.

NEJM. 2009;360:2216-23

June 21, 2012

Thrombocytopenia, in a patient with severe sepsis frequently heralds the onset of disseminated intravascular coagulation, is an independent predictor of multiple organ failure and poor outcome.

Annals of EM, Vol. 48, pg. 54

June 20, 2012

The classic symptoms of retinal detachment include "flashing lights", "floater" complaint, and "curtain-like or cloudy" painless vision loss.

Journal of Emerg Med. 2009;37:415

June 19, 2012

The classic triad of dural sinus thrombosis is headache, papilledema, and high CSF opening pressure. MRI with magnetic resonance venography is considered the gold standard for diagnosis.

Am J EM, Vol. 25, pg. 218

June 18, 2012

In patients receiving multiple inappropriate implantable cardioverter-defibrillator shocks, the device can be disarmed immediately by placing a magnet over the ICD pocket until it can be reprogrammed by the electrophysiologist.

JAMA, Vol. 296:2839

June 17, 2012

The first-line treatment for symptomatic patients with methemoglobinemia is methylene blue, which reduces ferric iron to restore normal hemoglobin structure and function.

Journal of Emerg Med, Vol. 35, pg. 445

June 16, 2012

A 6-mm ETT can be used as an alternative to a tracheostomy tube, when performing an emergency adult cricothyroidotomy,but this option is much less preferable because an ETT is more difficult to secure to the patient's neck.

NEJM, Volume 358:e25 May 29, 2008

June 15, 2012

Few patients experience a major vascular event after discharge home with a diagnosis of dizziness or vertigo, with a stroke occurring in less than 1 in 500 patients within the first month.

Emerg Med. 2011;57:34-41.

June 14, 2012

ST elevation in lead aVR in a patient with narrow complex tachycardia is strongly suggestive of WPW-related narrow complex tachycardia.

AJEM, Vol. 24:864

June 13, 2012

The addition of octreotide offers a significant advantage over glucose or glucagon alone in the management of refractory hypoglycemia due to its suppression of the secretion of endogenous insulin.

Journal of Emerg Med, Vol. 36, pg. 28

June 12, 2012

Initiation of effective antimicrobial therapy within the first hour after onset of septic shock-related hypotension was associated with 79.9% survival to hospital discharge.

Crit Care Clin 27 (2011) 53-76

June 11, 2012

Potential adverse events associated with ED propofol use include hypoxemia; respiratory depression, airway obstruction and apnea; hemodynamic instability; nausea; emesis; pain with injection.

Annals of Emerg Med;50(2):182-187.

June 10, 2012

Cocaine's ability to cause QRS-interval prolongation and to predispose to certain arrhythmias is well known and treated similarly to other QRS widening agents through administration of IV sodium bicarbonate (8.4%, 50 mEq NaHCO3 in 50 mL).

Emerg Med Clin N Am 28 (2010)

June 09, 2012

Patients poisoned by anticholinergic agents commonly present according to the following mnemonic: ""Hot as a Hare, Red as a Beet, Dry as a Bone, Blind as a Bat, and Mad as a Hatter.''

Emerg Med Clin N Am 28 (2010)

June 08, 2012

Untreated neonatal HSV infection is associated with only a 40% survival rate, and even with the early initiation of high-dose intravenous acyclovir therapy, it results in considerable disability among survivors.

NEJM Volume 361:1376-1385 October 1, 2009

June 07, 2012

With a careful history, physical examination, and directed investigation, physicians can determine the likely cause of syncope in more than 50% and perhaps up to 80% of patients.

Emerg Med Clin N Am 28 (2010) 471-485

June 06, 2012

The current literature does not support the routine practice of prescribing antibiotics after I&D of simple cutaneous abscesses, even in high-MRSA-prevalence areas. A > 90% rate of full resolution without complications can be expected whether or not antibiotics are prescribed after I&D.

Annals of Emerg Med; 50(1):49-51.

June 05, 2012

Studies have shown that the cause of syncope is diagnosed with variable degrees of certainty in only about 50% of patients after an initial ED evaluation and about 30% of patients remain undiagnosed on discharge from a hospital admission.

Emerg Med Clin N Am 28 (2010) 471-485

June 04, 2012

Incision and drainage (I&D) is the primary therapy for the management of cutaneous abscess - antibiotic treatment alone is inadequate; most localized skin abscesses without cellulitis can be managed without antibiotics.

NEJM;357(19):e20.

June 03, 2012

Plain radiographs (anteroposterior and lateral views) should be the first step only in cases of suspected infection, fracture, malignancy, or neurologic compromise when evaluating patient with lower back pain.

Emerg Med Clin N Am 28 (2010)

June 02, 2012

Patients who have severe thrombocytopenia and "wet purpura" should be aggressively treated with platelet transfusions because of the risk of fatal intracranial or intrapulmonary hemorrhage.

NEJM:357(6):580-587.

June 01, 2012

Studies evaluating CPAP in management of acute heart failure consistently showed significant improvements in oxygenation, reductions in heart rate,reductions in respiratory rate, and reductions in blood pressure compared with standard oxygen therapy.

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