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American Academy of Emergency Medicine

Fact of the Day - July 2012

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

July 31, 2012

In ACS trials comparing bivalirudin (a direct thrombin inhibitor) alone to the combination of heparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin was non-inferior in the prevention of thrombotic events and resulted in fewer associated bleeding complication.

EMCC/EB Medicine. Net, 2011, Volume 1, Number 4

July 30, 2012

C .difficile is a highly transmissible, gram-positive, spore-forming anaerobic bacterium that colonizes about 3% of healthy adults and 16% to 35% of hospitalized patients. This organism is identified as the cause in 10% to 25% of cases of antibiotic-associated diarrhea, 50% to 75% of antibiotic-associated colitis, and more than 90% of antibiotic-associated pseudomembranous colitis.

Emerg Med Clin N Am 29 (2011) 347–368

July 29, 2012

Tumor Lysis Syndrome: 2 or more of the following criteria within 3 days prior to or 7 days after initiation of chemotherapy:

  • Uric acid level: >= 8 mg/dL or 25% increase from baseline
  • Potassium level: >= 6.0 mEq/L or 25% increase from baseline
  • Phosphorus: >= 6.5 mg/dL for children
  • Phosphorus concentration: >= 4.5 mg/dL for adults or 25% increase from baseline
  • Calcium level: <= 7 mg/dL or 25% decrease from baseline

EBMedicine. net, March 2010

July 28, 2012

AHA recommends the use of amiodarone for VF or pulseless VT that is unresponsive to CPR, shock, and a vasopressor (class IIb recommendation) : Amiodarone is first given as a dose of 300 mg IV, which can be followed with a second dose of 150 mg IV after 5 minute.

Emerg Med Clin N Am 30 (2012) 65–75

July 27, 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. In particular, patients with new-onset seizure who present with fever, severe headache, immunocompromised state, or persistently altered mental status should undergo an LP.

Emerg Med Clin N Am 29 (2011) 41–49

July 26, 2012

Despite slight variations in readings, and depending on the experience of the radiologist, the overall accuracy of MRI for Epidural Spinal Cord Compression is high (93%sensitivity, > 97% specificity, > 95% positive predictive value).

EBMedicine. net, 2010

July 25, 2012

Bedside assessment by emergency physicians before spiral CT was sensitive in ruling out serious injuries in high-acuity trauma patients with a "very low" rating for injury. However, overalldiagnostic accuracy was low, suggesting that spiral CT should be considered in most high-acuity patients to prevent missing injuries.

American Journal of Emergency Medicine (2011) 29, 1–10

July 24, 2012

E coli 0157:H7 cause a hemorrhagic colitis due to a shiga-like cytotoxin that destroys the colonic microvilli. Patients infected with E coli may develop an acute onset of watery diarrhea, which may progress to bloody diarrhea, abdominal cramps, and vomiting. Fever is typically absent or low grade. Approximately 6% of patients with E coli 0157:H7 infection, particularly those younger than 5 years and elderly patients, develop hemolytic uremic syndrome.

Emerg Med Clin N Am 29 (2011) 211–237

July 23, 2012

Children with blunt head trauma and initial ED GCS scores of 14 or 15 and normal cranial CT scan results are at very low risk for subsequent traumatic findings on neuroimaging and extremely low risk of need in neurosurgical intervention. Hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary.

Ann Emerg Med. 2011;58:315-322

July 22, 2012

Ductus-dependent cardiac lesions: - Tetralogy of Fallot (with critical pulmonary stenosis) - Coarctation of the aorta - Tricuspid atresia - Hypoplastic left heart syndrome - Pulmonary atresia - Pulmonary stenosis (critical)

Clinical Pediatric Emergency Medicine, Volume 12, Issue 4 December, 2011

July 21, 2012

Post–cardiac arrest syndrome (PCAS), are grouped into 4 categories: systemic ischemia/reperfusion response, brain injury, myocardial dysfunction, and persistence of the precipitating cause of the arrest.

Emerg Med Clin N Am 30 (2012) 123–140

July 20, 2012

The CT scan is the study of choice for renal trauma, since it can determine degree of renal parenchymal injury, evaluate nonviable tissue, detect urine extravasation and perirenal fluid collections, and diagnose pedicle injuries.

Pediatric Emergency Medicine Practice , 2010, ebmedicine.net

July 19, 2012

Resuscitation efforts may be withheld in any blunt trauma patient who, based on out-of-hospital personnel's thorough primary patient assessment, is found apneic, pulseless, and without organized ECG activity upon the arrival of EMS at the scene.

EBMedicine. net, November 2009 Volume 1, Number 2

July 18, 2012

Differential Diagnosis For High Anion Gap:

  • Methanol, metformin
  • Caffeine, seizures
  • Benzyl alcohol, acetaminophen
  • Acetone
  • Ethanol, ethylene glycol, methanol
  • Mannitol
  • Osmotic contrast dyes
  • Propylene glycol
  • Isopropanol
  • Uremia
  • DKA, AKA
  • Paraldehyde, phenformin
  • Isoniazid, iron
  • Lactic acidosis
  • Ethylene glycol
  • Salicylates, theophylline

EBMedicine. net, 2010, Volume 12, Number 11

July 17, 2012

EPs in a wide range of settings have high rates of gallstone identification, with sensitivity of 88% to 96% and specificity of 78% to 96% when compared with radiology department ultrasonography.

Emerg Med Clin N Am 29 (2011) 293–317

July 16, 2012

In patient with acute upper gastrointenstinal bleeding, Clinical Rockall score greater than 0 and Blatchford score greater than 0 were sensitive predictors of the need for endoscopic therapy (95% and 100%) but were poorly specific (9% and 4%), with overall accuracies of 41% and 39%.

American Journal of Emergency Medicine (2012) 30, 129–134

July 15, 2012

CTA can be considered as the initial diagnostic study of choice in penetrating zone II neck trauma (as well as zone I and III).

Ebmedicine.net, March 2012, Volume 4, Number 3

July 14, 2012

There is insufficient evidence to suggest that acute treatment with inhaled beta-2 agonists should be avoided in patients with dyspnea who may have heart failure. Based on small studies and indirect evidence, administration of beta-2 agonists to patients with heart failure seems to improve pulmonary function, cardiovascular hemodynamics, and resorption of pulmonary edema.

The Journal of Emergency Medicine Volume 40, Issue 2 , Pages 135-145, February 2011

July 12, 2012

Hidradenitis suppurativa is a chronic, recurrent inflammatory disease affecting skin that bears apocrine glands. It usually develops after puberty, manifested as painful, deep-seated, inflamed lesions, including nodules, sinus tracts, and abscesses. In most patients, flares are accompanied by increased pain and suppuration at varying intervals, often occurring during the premenstrual period in women. If untreated, the flares subside within 7 to 10 days.

N Engl J Med 2012;366:158-164

July 11, 2012

The use of a combined alpha- and beta-blocker (e.g. labetalol) is controversial and remains poorly studied but “its use is reasonable and may be considered” for cocaine chest pain with hypertension (SBP >150 mm Hg) and tachycardia (HR >100 beats/min) if nitroglycerin or a CCB has been recently given for cocaine-associated chest pain.

Mayo Clin Proc 2011 Dec;86(12):1198-207

July 10, 2012

CPAP masks, noninvasive positive pressure ventilation, or PEEP valves on a bag-valve-mask device should be considered for pre-oxygenation and ventilation during the onset phase of muscle relaxation in patients who cannot achieve saturations greater than 93% to 95% with high FiO2.

Ann Emerg Med. 2012;59:165-175

July 09, 2012

Among patients presenting to the ED with an acute ICH, larger hematoma volumes are associated with higher morbidity and mortality; hematoma volume is the most accurate predictor of outcome.

Mayo Clin Proc, Vol. 82, pg. 987

July 08, 2012

According to the available evidence, outpatient treatment of acute uncomplicated diverticulitis may be a feasible treatment strategy for certain patients: those who are able to tolerate oral intake, have no significant co-morbidities, are able to obtain antibiotics, have adequate pain control, and have access to adequate follow-up and social support.

Ann Emerg Med. 2011;57:600-602

July 06, 2012

Acute septic arthritis involving 2 or more joints should raise a suspicion of Infective Endocarditis.

Mayo Clin Proc, Vol. 82, pg. 615

July 05, 2012

The classic triad of intermittent abdominal pain, red currant jelly stool (caused by venous congestion from obstruction), and a palpable mass occurs in a minority of patients (up to 40% of children) with intussusceptions.

Emerg Med Clin N Am 29 (2011) 401–428

July 04, 2012

Co-administered midazolam significantly reduces the incidence of recovery agitation after ketamine procedural sedation and analgesia in ED adults (number needed to treat 6). Adverse events occur at similar frequency by the IV or IM routes.

Ann Emerg Med. 2011;57:109-114

July 03, 2012

Patients with near syncope are as likely as those with syncope to experience critical interventions or adverse outcomes; however, near-syncope patients are less likely to be admitted.

American Journal of Emergency Medicine (2012) 30, 203–206

July 02, 2012

Cervical spine immobilization is not necessary in penetrating neck trauma without evidence of neurological deficit.

Ebmedicine.net, March 2012, Volume 4, Number 3

July 01, 2012

Wernicke's encephalopathy can occur with prolonged glucose or carbohydrate loading in the absence of thiamine. However, a single acute administration of glucose does not appear to cause this effect.

Ann of EM, Vol. 50, pg. 715