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American Academy of Emergency Medicine

Fact of the Day - June 2013

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

June 30, 2013

Class III shock is the first class in which there is a drop in the systolic blood pressure below 90mmHg.

Schofer JM, Mattu A, Colletti JE, Gray EA, Rogers RL, Shih RD, eds. Emergency Medicine: A Focused Review of the Core Curriculum Milwaukee, WI: American Academy of Emergency Medicine; 2008.

June 30, 2013

The overall prevalence of drug-related ED visits among lifetime drug users was 1.8%; for those with a lifetime drug use disorder, 3.7%. Persons with heroin dependence and inhalant dependence had the highest rates of ED visits, and marijuana dependence was associated with the lowest rates.

American Journal of Emergency Medicine (2011) 29, 704–710

June 29, 2013

Left ventricular (LV) pump failure has emerged as the leading cause of mortality in acute coronary syndromes (ACS), with overall ACS mortality ranging from 3% to 7% during the index hospitalization.

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

June 28, 2013

tPA is the first medication to be considered for the patient with spontaneous dissections and evidence of acute stroke. It is given in concordance with guidelines for typical ischemic stroke.

Ebmedicine.net 2012 Vol. 14 (4)

June 27, 2013

A systematic review showed that Acetazolamide is effective for the prevention of acute mountain sickness but may be associated with paresthesias. Sumatriptan and gabapentin are beneficial but require further study.

Ann Emerg Med. 2012; 59:307-317

June 26, 2013

SCIWORA may result from self-reducing intersegment deformity to the spinal cord or from injury to the vascular supply of the cord. It is more common in children because their bony spinal columns are more elastic.

JEM, Vol. 41, pg. 252

June 25, 2013

Desaturation to below 70% puts patients at risk for dysrhythmia, hemodynamic decompensation, hypoxic brain injury, and death.

Ann Emerg Med. 2012;59:165-175

June 24, 2013

The 4 metabolic derangements associated with the Tumor Lysis Syndrome: Hyperuricemia, Hyperphosphatemia, Hyperkalemia, and Hypocalcemia.

Mayo Clin Proc, Vol. 81, pg. 838

June 23, 2013

The deep sulcus sign, which is characterized by a deep, lucent, ipsilateral costophrenic angle on supine chest radiography, is an indirect sign of a pneumothorax.

NEJM, 2/9/12, pg. 552

June 22, 2013

Risk-stratification has a vital role in the emergency management of ACS. The GRACE score for predicting in-hospital mortality is calculated on admission, with a score between 1 and 258. Points are assigned for the following 8 variables:

  1. Older age
  2. Lower systolic blood pressure
  3. Increased heart rate
  4. Elevated creatinine
  5. Congestive heart failure Killip Class
  6. Cardiac arrest at presentation
  7. ST-segment deviation
  8. Elevated cardiac enzymes

EBmedicine.net, April 2012

June 21, 2013

The reported 30-day mortality for patients presenting to the ED with an acute myocardial infarction who receive a misdiagnosis is 9%.

Ann of EM, 2/12, pg. 115

June 20, 2013

Alcohol withdrawal produces a hyperautonomic state that can range in severity from mild tachycardia and tremor to hallucinations, seizures or frank delirium tremens, and death. Signs and symptoms of withdrawal are most likely to reach peak intensity 48 hours after a last drink, but there is wide variation in the onset, severity, and duration of symptoms.

American Journal of Emergency Medicine (2011) 29, 382–385

June 19, 2013

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

June 18, 2013

A greater ST elevation in lead III than lead II is often indicative of a right coronary artery occlusion manifesting as an RV infarct.

Mayo Clin Proc, Vol. 85, pg. e52

June 17, 2013

A retrospective propensity-score-matched case-control study showed that Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia. Treatment failure rates were similar between the two drugs, but adverse events were more common with nafcillin.

Antimicrob Agents Chemother 2011 Nov 55:5122

June 16, 2013

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 (delayed postpartum eclampsia).

NEJM, Vol. 360, pg. 1126

June 15, 2013

Simple UTIs (eg, cystitis in women) can be treated with 3 days of antibiotics; however, UTIs in men are considered “complicated” by definition and warrant at least 7 days of antibiotic therapy.

Mayo Clin Proc, Vol. 86, pg. 557

June 14, 2013

Nebulized racemic epinephrine delivered by helium-oxygen followed by helium-oxygen inhalation therapy delivered by HFNC was associated with a greater degree of clinical improvement compared with that delivered by oxygen among infants with bronchiolitis.

Arch Pediatr Adolesc Med 2011 Dec 165:1115

June 13, 2013

The differential diagnosis of a peripherally enhancing brain lesion should always include the following neoplastic processes: metastatic tumors, primary glial tumors, and primary lymphoma of the central nervous system.

N Engl J Med 2012;366:745-755

June 12, 2013

Acute sinusitis is most commonly viral in origin (eg, the common cold) and is estimated to occur 2-5 times per year in an average adult. Bacterial infection is thought to complicate only a very small percentage of cases: 0.5%-2.0%.

Mayo Clin Proc, 5/11, pg. 427

June 11, 2013

Alcohol produces seizures in patients with or without underlying foci by:

  • By partial or absolute withdrawal of alcohol after a period of chronic intake.
  • By an acute alcohol-related metabolic brain disorder (eg, hypoglycemia, hyponatremia).
  • By creating a situation leading to cerebral trauma.
  • By precipitating seizures in patients with epilepsy.
  • By persistent heavy intake of alcohol, independent of alcohol withdrawal.

Emerg Med Clin N Am 29 (2011) 117–124

June 10, 2013

The cause of most cases of acute-onset monocular floaters and/or flashes is posterior vitreous detachment.

JAMA, Vol. 302, pg. 2243

June 09, 2013

Tibial intraosseous access is found to have the highest first-attempt success for vascular access and the most rapid time to vascular access during out-of-hospital cardiac arrest compared with peripheral intravenous and humeral intraosseous access.

Ann Emerg Med. 2011;58:509-516

June 08, 2013

Kline et al published a prospective study in which clinicians used the PERC rule as part of standard care for 115 patients who were followed for outcomes at 2 weeks. Sixty-five of the 115 patients were PERC negative, and zero (0/65; 95% confidence interval 0% to 5.5%) had an outcome of pulmonary embolism.

Ann Emerg Med. 2012;59: 84-85

June 07, 2013

The prediction instrument for endocarditis in febrile injection drug users that used combination of best criteria including tachycardia, lack of skin infection, and cardiac murmur had a sensitivity of 100% (95% confidence interval, 84%-100%) and negative predictive value of 100% (95% confidence interval, 88%-100%).

American Journal of Emergency Medicine (2011) 29, 894–898

June 06, 2013

Ischemic bowel can be caused by 1 of 4 mechanisms: arterial thrombosis, arterial embolism, venous thrombosis, or non-occlusive mesenteric ischemia (NOMI). Survival rates vary depending on the mechanism. Overall mortality is as high as 60% to 80%, especially with delays in diagnosis or presentation of greater than 24 hours.

Emerg Med Clin N Am 29 (2011)

June 05, 2013

Current data suggest there is no difference between expectant care, misoprostol, and surgical treatment for incomplete miscarriage at less than 13 weeks of gestation.

Annals of Emergency Medicine , 2012; 59(4)

June 04, 2013

The diagnosis of RV infarction portends a poor prognosis for patients, with mortality increased by as much as 50% in patients who have LV infarcts that also involve the RV.

Mayo Clin Proc, 8/10, pg. e52

June 03, 2013

When Rh-positive fetal blood enters the circulation of an Rh-negative mother, maternal anti-D antibodies are produced. This process, called sensitization or alloimmunization, usually has no adverse effects during the pregnancy in which it occurs but results in an amplified immune response if further maternal exposure to the D antigen occurs during a subsequent pregnancy.

Ann of EM, ePub, Online 12/12/11

June 02, 2013

Review of 17 trials with a total of 1,998 patients demonstrated that compared to direct laryngoscopy, glidescope video-laryngoscopy is associated with improved glottic visualization, particularly in patients with potentialor simulated difficult airways.

Can J Anesth/J Can Anesth (2012) 59:41–52

June 01, 2013

When bedside pelvic ultrasonography does not demonstrate an intrauterine pregnancy, serum -hCG level is not helpful in differentiating intrauterine from ectopic pregnancy in symptomatic ED patients.

Ann Emerg Med. 2011;58:12-20