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American Academy of Emergency Medicine

Fact of the Day - September 2014

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

September 30, 2014

Although RMSF cases have been reported throughout most of the contiguous United States, five states (North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri) account for over 60% of RMSF cases.

Rocky Mountain Spotted Fever (RMSF). Statistics and Epidemiology. Centers for Disease Control and Prevention Rickettsial Zoonoses Branch. http://www.cdc.gov/rmsf/stats/index.html. Accessed June 25, 2014.

September 29, 2014

Intravenous propofol appears to be an efficacious and safe treatment for patients presenting with Migraine headache to the emergency department.

• Soleimanpour H, Ghafouri RR, Taheraghdam A, Aghamohammadi D, Negargar S, Golzari SE, Abbasnezhad M. Effectiveness of intravenous dexamethasone versus propofol for pain relief in the migraine headache: a prospective double blind randomized clinical trial. BMC Neurol. 2012 Sep 29;12:114. • Soleimanpour H, Taheraghdam A, Ghafouri RR, Taghizadieh A, Marjany K, Soleimanpour M. Improvement of refractory migraine headache by propofol: case series. Int. J. Emerg. Med. 2012; 5: 19–22. • Bloomstone JA. Propofol: a new treatment for breaking migraine headache. Anesthesiology 2007; 106: 405–6.

September 28, 2014

In children with acute asthma, 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone.

Qureshi F, Zaritsky A, Poirier MP. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. J Pediatr. 2001 Jul;139(1):20-6.

September 27, 2014

Bacteria are the most common cause of traveler’s diarrhea. Overall, the most common pathogen is enterotoxigenic Escherichia coli, followed by Campylobacter jejuni, Shigella spp., and Salmonella spp.

• Conner BA. For the Record: A History of the Definition & Management of Travelers’ Diarrhea. Chapter 2. Self-Treatable Conditions. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/travelers-diarrhea. Accessed June 25, 2014.

September 26, 2014

There is no good clinical evidence that helmets, mouth guards, or soccer headbands reduce the incidence or severity of concussion. Some data suggest neck strengthening can reduce the forces transmitted by to the brain and thereby reduce concussion.

• McCrory P, Johnston K, Meeuwisse WH, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005; 39:196-204. • Daneshvar DH, Baugh CM, Nowinski CJ, McKee AC, Stern RA, Cantu, RC. Helmets and mouth guards: the role of personal equipment in preventing sports-related concussions. Clin Sports Med. 2011; 30:145-163.

September 25, 2014

In the United States, acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure and is the second most common cause of liver failure requiring transplantation.

• Farrell SE et al. Acetaminophen Toxicity. MedScape. Updated: Jan 27, 2014. http://emedicine.medscape.com/article/820200-overview. Accessed June 25, 2014. • US Food and Drug Administration. June 29-30, 2009: Joint meeting of the Drug Safety and Risk Management Advisory Committee with the Anesthetic and Life Support Drugs Advisory Committee and the Nonprescription Drugs Advisory Committee: meeting announcement. Available at http://www.fda.gov/AdvisoryCommittees/Calendar/ucm143083.htm. Accessed June 25, 2014.

September 24, 2014

Patients had important information deficits when leaving the ED, and information transmission needs to be improved. The physician–patient discharge conversation seems an ideal opportunity for enhancing patient informedness. Standardization of discharge procedures and training physicians in how to ensure that patients actually understand the information provided are needed.

Hans Marty, Yvonne Bogenstätter, Gabriela Franc, Franziska Tschan, Heinz Zimmermann. Emerg Med J 2013;30:53-57 doi:10.1136/emergmed-2011-200451

September 23, 2014

Cats from large-scale hoarding cases had high risk for enteric and respiratory infections, retroviruses, and dermatophytosis. Case responders should be prepared for mass treatment of infectious diseases and should implement protocols to prevent transmission of feline or zoonotic infections during the emergency response and when transferring the rescued cats to other shelters or to adopters.

Polak KC, Levy JK, Crawford PC, et al. Infectious diseases in large-scale cat hoarding investigations. Vet J. 2014;14:1090-0233 doi:10.1016/j.tvjl.2014.05.020

September 22, 2014

The current literature suggests that dexamethasone can be used as an effective alternative to prednisone in the treatment of mild to moderate acute asthma exacerbations in children, with the added benefits of improved compliance, palatability, and cost. However, more research is needed to examine the role of dexamethasone in hospitalized children.

Meyer JS, Riese J, Biondi E. Is dexamethasone an effective alternative to oral prednisone in the treatment of pediatric asthma exacerbations? Hosp Pediatr. 2014;4:172-180 doi:10.1542/hpeds.2012-0088

September 21, 2014

Compared with patients without vomiting, the risk of death was significantly higher in patients with vomiting at the onset of stroke. Vomiting should be an early predictor of the outcome.

Kazuo Shigematsu, Osamu Shimamura, Hiromi Nakano, Yoshiyuki Watanabe, Tatsuyuki Sekimoto, Kouichiro Shimizu, Akihiko Nishizawa, Masahiro Makino. Emerg Med J 2013;30:728-731 doi:10.1136/emergmed-2012-201586

September 20, 2014

In this study, the authors demonstrated that patients admitted as emergencies to medicine on public holidays had significantly higher mortality at 7 and 30 days compared to patients admitted on other days of the week.

Smith S, Allan A, Greenlaw N, et al. Emergency medical admissions, deaths at weekends and the public holiday effect. Cohort study. Emerg Med J 2014;3131:30-34 doi:10.1136/emergmed-2012-201881

September 19, 2014

In this study half of the elderly patients underwent CT and they were immobilized significantly longer than younger patients. Thus the authors suggest that measures should be adopted to facilitate early diagnosis and mitigate complications of prolonged immobilization in elderly patients with neck trauma.

Edwards MA, Verwey J, Herbert S, et al. Cervical spine clearance in the elderly: do elderly patients get a bad deal? Emerg Med J 2014:31;591-592 doi:10.1136/emergmed-2012-202256

September 18, 2014

The use of corticosteroids decreases pain and time to symptom resolution in patients with sore throat, especially in those patients with exudative pharyngitis.

Welch JL, Cooper DD. Do corticosteroids benefit patients with sore throat? Ann Emerg Med. 2014;6:711-712 doi:10.1016/j.annemergmed.2013.07.011

September 17, 2014

There is no significant difference in compression rate and depth between CPR performed on manikins placed on the floor and those placed at a rescuer’s knee height

Oh JH, Kim CW, Kim SE, Lee, et al. Comparison of chest compressions in the standing position bedside a bed at knee level and the kneeling position: a non-randomized, single blind, cross-over trial. Emerg Med J 2014;31:533-535 doi:10.1136/emergmed-2013-202443

September 06, 2014

  • ≥37 weeks gestation, and hospitalized no longer than the mother
  • Infant was previously healthy
  • Infant was well-appearing, with no ear, soft tissue, or bone infections

Laboratory criteria were as follows:

  • WBC 5,000 to 15,000/microL with an absolute band count <1,500/microL
  • Urinalysis with <10 WBC/hpf and no bacteria seen
  • Stool with <5 WBC/hpf if obtained

Strategies for the evaluation of fever in neonates and infants (less than three months of age).Literature review current through: Feb 2014. | This topic last updated: May 9, 2013, Uptodate article accessed 3/22/14

September 05, 2014

Testing the gait of a child who normally is ambulatory will help to evaluate for occult joint infections.

Harwood and Nuss Clinical Practice of Emergency Medicine Fifth Edition Lippincott, Philadelphia, 2010

September 04, 2014

Free water needs for a 24 hour period are 100ml/kg/24 hour for the first 10kg, 50ml/kg/24 hr for second 10kg, and 20ml/kg/24hr for body weight over 20 kg.

Harwood and Nuss Clinical Practice of Emergency Medicine Fifth Edition Lippincott, Philadelphia, 2010

September 03, 2014

A very low serum bicarbonate has been associated with a higher clinical degree of dehydration in pediatric patients

Harwood and Nuss Clinical Practice of Emergency Medicine Fifth Edition Lippincott, Philadelphia, 2010

September 02, 2014

The potential for dehydration is inversely proportional to the child's age. Total body water and the percentage of daily fluid turnover are highest in infants younger than 6 months old. In these infants rotaviral gastroenteritis, shigellosis, or salmonellosis can cause dehydration in minutes to hours.

Harwood and Nuss Clinical Practice of Emergency Medicine Fifth Edition Lippincott, Philadelphia, 2010

September 01, 2014

The CHEST guidelines atrial fibrillation and atrial flutter state that patients should receive peri-procedure anticoagulation and be continued on oral anticoagulation for 4 weeks following cardioversion, but these suggestions are rated 2C and have no quality evidence supporting them.

You JJ, Singer DE, Howard PA, et al. Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e531S-75S.