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American Academy of Emergency Medicine

Fact of the Day - August 2013

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

August 31, 2013

The classic presentation of Wernicke’s encephalopathy is confusion, ataxia, ophthalmoplegia, and nystagmus.

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.

August 30, 2013

Indgestion of methanol causes anion gap acidosis and an osmolar gap. The primary manifestations are visual symptoms with optic disc hyperemia secondary to formic acid. It is treated with fomepizole, ethanol, or dialysis.

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.

August 29, 2013

Ingestion of ethylene glycol causes anion gap acidosis and an osmolar gap. It is treated with ethanol or fomepizole.

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.

August 28, 2013

The combination of anion gap metabolic acidosis with respiratory alkalosis is aspirin toxicity until proven otherwise. Aspirin can also cause hyperthermia, hypoglycemia, and hypokalemia.

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.

August 27, 2013

Serum alkalinization is useful for TCA toxicity, with a goal blood pH of 7.5. Urine alkalinization is useful for salicylates, chlorpropamide, and barbiturates, with a goal urine pH >7.5.

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.

August 26, 2013

Drugs for which hemodialysis may be effective can be remembered with the mnemonic STUMBLE: salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol. “U” stands for “uremia” and serves as a reminder that patients who are uremic or in renal failure may also need dialysis to help eliminate the drug.

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.

August 25, 2013

Charcoal is not useful for lithium, alkalis/acids, iron, and other heavy metals.

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.

August 24, 2013

Every toxicology case on the boards that has an ECG associated with it is either TCA or digoxin toxicity.

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.

August 23, 2013

Paroxysmal atrial tachycardia with variable AV block is digoxin toxicity until proven otherwise.

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.

August 22, 2013

Anytime a toxicology patient has a tachycardic ECG, look for signs of tricyclic antidepressant (TCA) toxicity: large S in I and aVL, R >3 mm in AVR, wide QRS complex, sinus tachycardia, long QT interval.

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.

August 21, 2013

The classic triad of Reiter’s syndrome consists of arthritis, conjunctivitis, and non-gonococcal urethritis triggered by Chlamydia or a gastrointestinal 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.

August 20, 2013

Adrenocortical insufficiency is caused by previous steroid therapy, tumors, infection, hypothalamic-pituitary insufficiency, and adrenal hemorrhage. It presents as vasomotor collapse and is treated with hydrocortisone, 100 mg IVq6-8h.

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.

August 19, 2013

The hyponatremia associated with SIADH should be corrected slowly to avoid central pontine myelinolysis and cerebral demyelination.

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.

August 18, 2013

Thrombotic thrombocytopenic purpura (TTP) presents classically with thrombocytopenia, hemolytic anemia, fluctuating neurologic changes, renal disease, and fever. It is treated with plasma exchange with FFP, steroids, and antiplatelet drugs (e.g., aspirin).

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.

August 17, 2013

G6PD deficiency — the most common human enzyme defect — presents in association with acute hemolytic crises incited by infection, administration of oxidant drugs (e.g., sulfa, phenazopyridine, antimalarials, salicylates), metabolic acidosis (such as DKA), and ingestion of fava beans.

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.

August 16, 2013

Causes of vulvovaginitis and associations: • Trichomonas vaginalis – grey/yellow frothy malodorous discharge; treated with metronidazole or clindamycin • Gardnerella vaginalis – “fishy” odor, clue cells; treated with metronidazole or clindamycin • Candida albicans – white “cottage cheese” discharge; treated with topical or oral antifungals

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.

August 15, 2013

An intrauterine pregnancy (IUP) can be visualized by transvaginal ultrasound when the quantitative b-hCG level is between 1500 and 2000 IU/ml and by transabdominal ultrasound when the level is greater than 6500 IU/ml. If an IUP is not visualized and the quantitative HCG concentration is above these discriminatory zones, ectopic pregnancy should be assumed until proven otherwise.

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.

August 14, 2013

Preeclampsia is characterized by hypertension, headache, visual disturbances, edema, and abdominal pain in a patient >20 weeks pregnant. HELLP syndrome is a form of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. Eclampsia is preeclampsia combined with seizures, which usually responds to magnesium and antihypertensive therapy, with delivery as the ultimate definitive 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.

August 13, 2013

Thromboembolism is the primary cause of maternal mortality in the United States. For the treatment of thromboembolic disease in pregnant women, heparin is the drug of choice because coumadin is contraindicated.

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.

August 12, 2013

Postmenopausal women with vaginal bleeding must have close follow-up to exclude endometrial carcinoma.

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.

August 11, 2013

In central cord syndrome, upper extremity weakness is much greater than lower extremity weakness. In anterior cord syndrome, there is loss of motor function and pain/temperature sensation distal to the lesion, with preservation of vibration, position, and touch. Spinal shock produces complete loss of reflexes and paralysis.

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.

August 10, 2013

Neuroleptic malignant syndrome is characterized by severe extrapyramidal dysfunction, altered mental status, hyperthermia, and autonomic disturbances following neuroleptic use with an elevated CPK. Treat with dantrolene and bromocriptine.

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.

August 09, 2013

The infant form of botulism occurs in infants who eat raw honey containing C. botulinum spores and is characterized by constipation, lethargy, failure to thrive, paralysis, and death if not treated.

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.

August 08, 2013

Myasthemia gravis (MG) is caused by antibodies to the acetylcholine receptors of the neuromuscular junction. It commonly occurs in young females and causes ptosis, diplopia, and proximal muscle weakness. Edrophonium, 1 to 2mg IV, resolves the symptoms of MG but can cause respiratory arrest or bradycardia in patients with cholinergic crisis; therefore, have airway equipment and atropine at the bedside.

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.

August 07, 2013

Subarachnoid hemorrhage is associated with polycystic kidney disease and aortic coarctation.

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.

August 06, 2013

Common side effects of medications used in patients with HIV/AIDS: • Didanosine: pancreatitis • Indinavir: nephrolithiasis • Isoniazid: hepatitis • Trimethoprim-sulfamethoxazole: hypokalemia, Stevens-Johnson syndrome • Ritonavir: parasthesias • Pentamidine: hyperglycemia or hypoglycemia • Dapsone: hepatitis

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.

August 05, 2013

The treatment of priapism includes external compression, subcutaneous terbutaline, and intracavernous injection of dilute phenylephrine.

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.

August 04, 2013

Cytomegalovirus (CMV) retinitis is the most common cause of blindness 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.

August 03, 2013

If the patient has signs and symptoms of Lyme disease but has leukopenia, thrombocytopenia, or elevated liver function tests (LFTs), suspect erhlichiosis.

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.

August 02, 2013

The classic funduscopic appearance of central retinal vein occlusion is a “blood and thunder” fundus. The classic funduscopic appearance of central retinal artery occlusion is a cherry red spot and a pale retina.

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.

August 01, 2013

Patients with cavernous sinus thrombosis are toxic appearing with elevated temperature, proptosis, eyelid edema, chemosis, cranial nerve III–VI palsies, as well as engorgement of the fundus. Management involves ENT consultation, antibiotics, and admission.

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.