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American Academy of Emergency Medicine

Fact of the Day - January 2014

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

January 31, 2014

Gram Negative Sepsis is the most common cause of ARDS. Other leadings causes are trauma, multiple transfusions, acute neurologic injuries, and cancer therapy.

Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010

January 30, 2014

Symptoms of retinal detachment include floaters, painless loss of vision, and light flashing.  Ultrasound may aid in the diagnosis of retinal detachment with the swirling effect, known as the “washing machine” sign.  This is seen on the image as a patient looks side to side and occurs from hemorrhage and tethered retina.

Ma, O. Emergency Ultrasound. 2nd Edition. New York, NY: McGraw-Hill; 2008.

January 29, 2014

Sporotrichosis is a fungal infection via inoculation of soil through the skin by Sporothrix schencki.  Most common manifestation is ulceration at site of inoculation and proximal lymphatic skip lesions.  Treatment includes 3–6 months of itraconazole.

Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011

January 28, 2014

Adenosine has a tremendous safety profile and brief half-life (<10 sec). Common drugs which prevent binding of adenosine and therefore may require larger doses of adenosine include methylxanthines, theophylline, and caffeine.

Marx, John. Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier; 2010

January 27, 2014

Disequilibrium syndrome includes acute complications associated with the rapid removal of urea during hemodialysis.  This causes a spectrum of neurologic symptoms ranging from nausea to seizures and even death.  Standard of care is supportive.  ‘Some sources state seizures can be reversed more rapidly by raising the plasma osmolality with either 5 mL of 23 percent saline or 12.5 g of hypertonic mannitol’.

Bergman H, Daugirdas JT, Ing, TS: Complications during hemodialysis, in Daugirdas JT, Blake PG, Ing TS (eds): Handbook of Dialysis. Philadelphia, Lippincott Williams & Wilkins; 2001

January 26, 2014

CSF shunt infections may have a normal CSF analysis from a lumbar puncture but a positive culture. Therefore, to analyze CSF from shunt infections, CSF must be obtained from the shunt.  The most common organism is Staphylococcus epidermidis, which occurs about 50% of the time.

Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011

January 25, 2014

More proximally limb amputations have a better prognosis because they have less muscle mass to oxygenate and therefore tolerate ischemia better.  Digits can tolerate up to 8 hrs of ischemia while limbs require replantation within 4-6 hrs.

Davenport M. Injuries to the Arm, Hand, Fingertip, and Nail. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011.

January 24, 2014

The sparing of the pupillary light reflex helps to differentiate this mononeuropathy from one caused by a tumor or aneurysm.

Stettler BA: Brain and Cranial Nerve Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 103: p. 1384.

January 23, 2014

The best way to estimating radiation dose exposure and prognosis is to use the  Andrews lymphocyte depletion curves.  The 48 hour period curve measures decline of  lymphocyte levels.

Rella J, “Radiation,” in Goldfrank’s Toxicologic Emergencies, edited by Flomenbaum NE, Goldfrank LR, Hoffman RS, et al., 1803-1816. New York: The McGraw-Hill Company, 2006.

January 22, 2014

Most common cranial nerve injured is CN VII.  This is usually demonstrated with a facial droop.

Reference: Marx, John. Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier; 2010

January 21, 2014

The Epley Maneuver, a series of sequential head movements, can improve symptoms of Benign Paroxysmal Peripheral Vertigo by repositioning canaliths from the semicircular canal.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 20, 2014

Hypothermic resuscitation is best accomplished with warm normal saline rather than lactated ringers.  This is because lactated ringers are poorly metabolized with a cold liver.

Question: What fluid should be used to a patient?

Answer: Normal saline because lactated ringers is poorly metabolized by the cold liver.

References: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011

January 19, 2014

Subarachnoid hemorrhage, while accounting for only 10% of all strokes, is the most common cause of sudden death from a stroke. It should be ruled out by CT and lumbar puncture in suspected cases

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 18, 2014

Amantadine and rimantadine can reduce the duration of symptoms from influenza A by one to two days if started within two days of symptoms onset. They have no effect against influenza B.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 17, 2014

Bats are the second most common vector for rabies transmission in the US, after raccoons, but in most cases contact with bats was only identified during hospitalization or after death.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 16, 2014

Frostbite injuries should be rewarmed actively in 40-42 degree circulating water, but should not be rewarmed in the field if there is a chance of re-freezing.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010

January 15, 2014

Osteomyelitis due to S. Aureus can cause Toxic Shock Snydrome in addition to sepsis and local effects. It should be treated with early goal directed therapy and source control.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 13, 2014

Fab fragment therapy has a 90% response date in both acute and chronic digitalis poisoning and causes allergic reactions in less than 1% of patients.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 12, 2014

Initial treatment of patients with severe anticholinergic poisoning should focus on cooling, hydration, and controlling agitation with titrated benzodiazepines.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 11, 2014

In cocaine-induced myocardial ischemia, beta-blockers are contraindicated due to potential to worsen coronary vasospasm. Benzodiazepines should be given as they will decrease myocardial oxygen demand.

Marx JA, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.

January 10, 2014

Cyanosis is evident on physical examination when the absolute amount of desaturated hemoglobin in the circulating capillary blood is elevated to approximately 5 g/dL.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 14: Cyanosis. Philadelphia, PA: Mosby/Elsevier, 2013

January 09, 2014

Although hemoptysis is commonly seen in the ED, only 1 to 5% of hemoptysis patients have massive or life-threatening hemorrhage (generally accepted at 100 to 600mL of blood loss in any 24-hour period).

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 24: Hemoptysis. Philadelphia, PA: Mosby/Elsevier, 2013

January 08, 2014

Clinical jaundice is usually not evident until the total serum bilirubin concentration rises above 2.5 mg/dL.  It is observed in tissues with high albumin concentrations, for example, the skin and eyes.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 28: Jaundice. Philadelphia, PA: Mosby/Elsevier, 2013

January 07, 2014

Peptic ulcers make up more than half of all acute cases of upper gastrointestinal bleeding seen in the emergency department.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 30: Gastrointestinal Bleeding. Philadelphia, PA: Mosby/Elsevier, 2013

January 06, 2014

The most common causes of injury in pregnancy, in order of frequency, that results in emergency department visits are motor vehicle collisions, interpersonal violence, and falls.

: Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 37: Trauma in Pregnancy. Philadelphia, PA: Mosby/Elsevier, 2013

January 05, 2014

Arterial hypotension, defined as a systolic blood pressure below 100 mmHg, is measured at least one time in 19% of ED patients; however, diagnosed traumatic, cardiogenic, or septic shock is less common, constituting about 1 to 3% of all ED visits.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 6: Shock. Philadelphia, PA: Mosby/Elsevier, 2013

January 04, 2014

Emergency department visits for dog bites decreased 14% between 2001 and 2008.  The breeds most frequently responsible for fatalities include pit bull (59%), Rottweiler (14%), American Bulldog and Siberian Husky (5% each), and German Shepard (3%).

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 61: Mammalian Bites. Philadelphia, PA: Mosby/Elsevier, 2013

January 03, 2014

Treatment of isolated soft tissue injury to the eyelids and surrounding area is symptomatic.  Head elevation and intermittent cold compresses started in the emergency department and continued for up to 48 hours may decrease the pain and swelling.  Complete resolution takes 2 to 3 weeks.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 71: Opthalmology. Philadelphia, PA: Mosby/Elsevier, 2013

January 02, 2014

S. pneumonia is a gram-positive coccus that is the most common cause of CAP in adults requiring hospitalization.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 76: Pneumonia. Philadelphia, PA: Mosby/Elsevier, 2013

January 01, 2014

The incidence of Infective Endocarditis associated with injection drug use is estimate at 150 to 2000 per 100,000 person-years. Although any valve can be affected, injection drug use is classically associated with right-sided endocarditis.

Marx JA, Hockberger RS, Walls RM, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice 8th Edition. Ch 83: Infective Endocarditis and Valvular Heart. Philadelphia, PA: Mosby/Elsevier, 2013