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American Academy of Emergency Medicine

Fact of the Day - July 2013

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

July 31, 2013

Xanthochromia occurs when the supernatant of centrifuged CSF is yellow-orange. It is a sign of RBC breakdown products from subarachnoid hemorrhage.

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.

July 30, 2013

The ester local anesthetics only have one “i” in their name, while the amides have two. If a patient is allergic to an agent in one class, it is safe to use a preservative-free agent from the other class or diphenhydramine for local anesthesia. Note benzocaine can precipitate methemoglobinemia in usual doses.

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.

July 29, 2013

Tracheal tube size in infants and children is calculated using the following formula: tube size = (4 + age in years)/4

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.

July 28, 2013

Kawasaki’s disease is treated with ASA and IVIG. It is defined by fever for 5 days or longer and the presence of four of the following five conditions: • Bilateral non-exudative conjunctivitis • Changes of the lips and oral mucosa (fissured lips, strawberry tongue) • Changes in the extremities (erythema of the palms and soles, edema, periungal desquamation) • Polymorphous rash • Cervical adenopathy (≥1.5 cm in diameter)

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.

July 27, 2013

Roseola, caused by human herpes virus 6, produces a high fever for 3 to 5 days, followed by defervescence and a rash.

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.

July 26, 2013

Erythema infectiosum (fifth disease), caused by parvovirus B19, gives patients a “slapped cheek” appearance. It can cause aplastic crisis in patients with sickle cell disease.

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.

July 25, 2013

Gingivostomatitis in the anterior mouth is associated with herpes simplex virus infection; posterior involvement suggests Coxsackievirus infection.

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.

July 24, 2013

Hyponatremia, hyperkalemia, and hypoglycemia are seen in patients with congenital adrenal hyperplasia. Adrenal crisis should be considered in any newborn with circulatory collapse within the first few weeks of life that is unresponsive to intravenous fluids. Many patients with this condition have ambiguous genitalia. Treatment includes hydrocortisone IV and therapy for hyperkalemia.

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.

July 23, 2013

Cyanosis that does not respond to oxygen may indicate a congenital heart lesion. Remember the five “terrible Ts” of cyanotic congenital heart disease: tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, truncus arteriosus, and total anomalous pulmonary venous return.

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.

July 22, 2013

Currant jelly stools are a late finding in patients with intussusception. Complaints of vomiting without diarrhea and a low-grade fever, with associated lethargy and/or colicky episodes of pain, should raise suspicion for intussusception.

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.

July 21, 2013

Classic pneumonia associations: • After influenza – Staphylococcus aureus • During pregnancy – varicella • With abdominal pain, vomiting/diarrhea, abnormal liver function tests (LFTs), or hyponatremia – Legionella pneumophila • With bullous myringitis – Mycoplasma

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.

July 20, 2013

The risk factors for severe bronchiolitis or apnea include age <3 months, respiratory rate >70 breaths/min, congenital cardiopulmonary disease, prematurity (<34 weeks’ gestation), immunodeficiency, and SaO2 <95%.

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.

July 19, 2013

Consider the diagnosis of active TB in homeless people, alcoholics, HIV-positive (or otherwise immunosuppressed) individuals, previously incarcerated people, as well as immigrants from (or recent travelers to) countries with high rates of TB; not all will have a pulmonary complaint.

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.

July 18, 2013

Cryptosporidium is the most common cause of chronic diarrhea in patients with AIDS.

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.

July 17, 2013

E. coli O157:H7 is associated with the development of hemolytic uremic syndrome in children and thrombotic thrombocytopenic purpura in the elderly.

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.

July 16, 2013

Yersinia infection may cause terminal ileitis that mimics appendicitis.

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.

July 15, 2013

Common associations in diarrhea:

  • Pet turtle or iguana, sickle cell anemia, splenectomy, after eating poultry or eggs – fecal WBCs are present– Salmonella
  • After eating poultry or meat – fecal WBCs are not present – Clostridium perfringens
  • Recent antibiotics – Clostridium difficile
  • After eating potato salad or mayonnaise – Staphylococcus aureus
  • After eating fried rice – Bacillus cereus
  • After eating raw oysters – Vibrio cholera
  • After drinking from natural water sources – Giardia lamblia
  • AIDS patient – Isospora or Cryptosporidium

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.

July 14, 2013

Crohn’s disease is characterized by involvement of all layers of the bowel wall, causing fistulas and abscesses. It can “skip” parts of the GI tract, but can involve any portion of it, and spares the rectum. In contrast, ulcerative colitis affects only the mucosa, with continuous involvement of the GI tract. It is usually limited to the colon and extends to the rectum.

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.

July 13, 2013

Upper GI procedures are the most common cause of esophageal rupture and are now more common than the classic Boerhaave’s syndrome (vigorous retching/vomiting). Suspect Boerhaave’s syndrome in the alcoholic with vomiting and chest pain or a left pleural effusion.

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.

July 12, 2013

Physical exam findings in endocarditis:                                   
Janeway lesions – nontender plaques on the palms and soles
Osler’s node – a tender nodule that appears on the tips of the fingers or toes
Roth spot – a retinal hemorrhage with central clearing

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.

July 11, 2013

The most common cause of left-sided endocarditis is Streptococcus viridans. The most common cause of right-sided endocarditis is Staphylococcus aureus from IV drug abuse.

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.

July 10, 2013

Torsades de pointes is treated by cardioversion in unstable patients and with magnesium or overdrive pacing in stable patients.

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.

July 09, 2013

The electrocardigraphic findings in pericardial tamponade include electrical alternans, tachycardia, and low voltage.

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.

July 08, 2013

Accelerated idioventricular rhythm is an ectopic rhythm of ventricular origin at a rate between 40 and 100 beats/min, which occurs after administration of thrombolytic therapy. It does not require treatment.

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.

July 07, 2013

In patients with wide-complex Wolff-Parkinson-White (WPW) syndrome, avoid medications that block the AV node but not the bypass tract, such as digoxin and calcium channel blockers. Procainamide and cardioversion are safe in these patients.

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.

July 06, 2013

Infective organisms specific to various bites are listed below: 
Human bite – Eikenella corrodens
Cat bite – Pasteurella multocida
Dog bite – Capnocytophaga canimorsus

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.

July 05, 2013

The classic mechanism producing a Jefferson fracture, or burst fracture of C1, is an axial load. A Hangman’s fracture involving the posterior elements of C2 is produced by severe hyperextension.

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.

July 04, 2013

Uncal herniation — the most common type of herniation — causes compression of the oculomotor nerve and an ipsilateral fixed and dilated pupil.

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.

July 03, 2013

The most common cause of coma following head injury is diffuse axonal injury.

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.

July 02, 2013

The most common traumatic cerebral bleed is subarachnoid hemorrhage.

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.

July 01, 2013

The most commonly injured abdominal organ in stab wounds is the liver. The most commonly injured abdominal organ in blunt trauma is the spleen.

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.