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American Academy of Emergency Medicine

Fact of the Day - February 2015

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

February 28, 2015

Cyanide toxicity is a known complication of inhalation injury; some studies suggest that upwards of 70% of these patients will develop cyanide toxicity. Neurologic impairment is a common sign of cyanide toxicity, as well as hypertension, tachycardia and tachynpea. Severe toxicity can lead to bradycardia, bradypnea, pulmonary edema, and eventually cardiovascular collapse. Treatment consists of supportive care and possible antidotes including hydroxycobalamin or sodium thiosulfate.

MacLennan L, Moiemen N. "Management of cyanide toxicity in patients with burns." Burns. 2014 Jun 30. S0305-4179(1)00210-1.

February 27, 2015

In posterolaterally displaced supracondylar fractures the brachial artery and median nerve are at risk for injury. Compartment syndrome can be a common complication.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 897.

February 26, 2015

Children are more likely than adults to develop diffuse cerebral swelling, increased ICP, and altered mental status with blunt head trauma.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 887.

February 25, 2015

Headaches are the most commonly reported symptom in carbon monoxide poisioning.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 299.

February 24, 2015

Predictors of a mass causing a headache include: symptoms <6 mo., sleep-related headache, vomiting, confusion, absence of visual symptoms, absence of family history of migraines, and abnormal neurological findings.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 881.

February 23, 2015

CT is 98% sensitive in diagnosing a subarachnoid hemorrhage when done within 12 hours of the onset of symptoms. Sensitivity decreases to 93% at 24 hours.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 1119.

February 22, 2015

Inferior wall MI’s need a right-sided EKG to rule out right ventricular infarction which would show up as an ST-segment elevation in V4R.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 370.

February 21, 2015

After 4 days, consider delayed wound closure for wounds initially not closed due to high risk of infection.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 299.

February 20, 2015

According to the American Academy of Pediatrics, if there is no apparent source of infection test for UTI in all girls, boys <1, and uncircumcised boys <2 years old.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 755.

February 19, 2015

The Philadelphia Protocol is recommended for assessing fever in well-appearing neonates and infants.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 754.

February 18, 2015

In children less than 3 months of age fever is concerning if it is greater than 38C (100.4F), this increases to 39C (102.2F) in children 3-36 months of age.

Tintinalli JE, Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw Hill Medical; 2011: 750.

February 17, 2015

20-25% of new diagnoses of Inflammatory Bowel Disease are in children. Anemia and elevated ESR are seen in most children with moderate to severe disease.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 16, 2015

Acute cholecystitis is rare in children. Stones in children are most commonly from hemolytic disease or total parenteral nutrition.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 15, 2015

Children with pneumonia may present with the primary complaint of abdominal pain.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 14, 2015

Strep. pharyngitis can cause abdominal pain and does not necessarily present with sore throat. In any child greater than or equal to 3 years who presents with abdominal pain, examine their oropharynx.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 13, 2015

Constipation should not cause a toxic appearance. If the child appears toxic, think of other etiologies. Hirschsprung's disease is a pathologic cause of constipation in infants, it is more common in those with trisomy 21, and is suggested by failure to pass meconium in the first 24-48 hours of life.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 12, 2015

According to Tintinalli's, the "rule of threes" by Wessel is a mnemonic to remember colic. It is crying greater than 3 hours per day, greater than 3 days per week, for greater than 3 weeks.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 11, 2015

Inguinal hernias are most common in children born prematurely and incarcaration is most common during the first year of life.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 10, 2015

Intussusception typically presents with intermittent pain and lethargy and is difficult to dignose because these are insensitive signs. Air contrast enema is diagnostic and therapeutic.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 09, 2015

Volvulus in children in a surgical emergency. It typically presents with abdominal pain, bilious vomiting, abdominal distension, and irritability. Upper GI series with contrast is the diagnostic test of choice.

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 08, 2015

Pathognomonic findings for necrotizing enterocolitis are pneumatosis intestinalis and portal venous gas. It is most often seen in premature infants, is usually managed medically, and has a high mortality rate (15-30%).

Fleischman RJ. Fleischman R.J. Acute Abdominal Pain in Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915462. Accessed August 31, 2014.

February 07, 2015

The negative predicitve value of B-type natriuretic peptide in diagnosing heart failure is 96%.

Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347:161.

February 06, 2015

While coronary artery aneurysms are the most common cardiac finding in Kawasaki disease, physicians should also consider coronary arteritis, valvular regurgitation and pericardial effusion as potential complications.

Son MB, Gauvreau K, Ma L, et al. Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from 2001 to 2006. Pediatrics 2009; 124:1.

February 05, 2015

In children with acute infectious mononucleosis, co-administration of amoxicillin may cause a morbilliform rash in less than half of patients, much lower than previously estimated values which were as high as 90%

Chovel-Sella A, Ben Tov A, Lahav E, Mor O, Rudich H, Paret G, Reif S. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pediatrics. 2013 May;131(5):e1424-7. doi: 10.1542/peds.2012-1575. Epub 2013 Apr 15.

February 04, 2015

Radiopaque toxins that may be seen on plain X-ray can be memorized with the pneumonic CHIPES. C: Chlorinated hydrocarbons, Calcium salts, Crack vials; H: Heavy metals; I: Iodinated compounds; P: Psychotropics, Packets of drugs (cocaine/heroin body packers), Play-Do, Potassium salts; E: Enteric-coated tablets (aspirin), S: Salicylates, sodium salts, sustained-release preparations.

Savitt DL, Hawkins HH, Roberts JR. The radiopacity of ingested medications. Ann Emerg Med 1987; 16:331.

February 03, 2015

Major risk factors for pulmonary embolism in children are oral contraceptive use and termination of pregnancy in females and trauma in males.

Bernstein D, Coupey S, Schonberg SK. Pulmonary embolism in adolescents. Am J Dis Child 1986; 140:667.

February 01, 2015

Prothrombin complex concentrates for patients with gastrointestinal hemorrhage while on warfarin, as compared with fresh frozen plasma, is associated with quicker reversal of INR, less bleeding on endoscopy, and shorter ED length of stay.

Karaca MA, Erbil B, Ozmen MM. Use and effectiveness of prothrombin complex concentrates vs fresh frozen plasma in gastrointestinal hemorrhage due to warfarin usage in the ED. The American journal of emergency medicine. Jun 2014;32(6):660-664.