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American Academy of Emergency Medicine

Fact of the Day - September 2015

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

September 30, 2015

In children aged 1-24 months, the Miller and the Macintosh blades provide similar laryngoscopic views and intubating conditions.

Varghese E, Kundu R. Does the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children? Paediatr Anaesth. 2014 Aug;24(8):825-9.

September 29, 2015

Supplemental oxygen therapy in patients with ST-Elevation myocardial infarction but without hypoxia may increase early myocardial injury and was associated with larger myocardial infarct size assessed at 6 months.

Stub, D, Smith, K, Bernard, S. et al. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation 2015 Jun16; 131(24): 2143-50.

September 28, 2015

Distal DVTs are defined as occurring below the knee. While symptomatic distal DVTs should be treated with anticoagulation, controversy exists regarding the best strategy for the management of asymptomatic distal DVTs. For low risk patients with asymptomatic distal DVTs, either outpatient ultrasound surveillance for two weeks or anticoagulation is appropriate given current evidence.

1. Masuda EM, Kistner RL, Musikasinthorn C, Liquido F, Geling O, & He Q. The controversy of managing calf vein thrombosis. J Vasc Surg 2012; 55 (2): 551. 2. Schwarz T, Buschmann L, Beyer J, Halbritter K, Rastan A, Schellong S. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg. 2010;52(5):1246. 3. Macdonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 2003;37(3):523.

September 27, 2015

In MAOI overdose, symptom onset is generally not seen for 6-12 hours.

Block BK, Cheung DS, Platts-Mills TF. First Aid for the Emergency Medicine Boards. New York, NY: McGraw-Hill; 2012. Chapter 6 Toxicology.

September 26, 2015

Pneumonia is the most common infection in elderly patients. Elderly patients with pneumonia may have nonrespiratory complaints such as falling, GI symptoms, delirium, confusion, functional decline, or weakness.

Emerman CL, Anderson E, Cline DM. Emerman C.L., Anderson E, Cline D.M. Emerman, Charles L., et al.Community-Acquired Pneumonia, Aspiration Pneumonia, and Noninfectious Pulmonary Infiltrates. 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. Judith E. Tintinalli, et al.eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915396. Accessed July 15, 2015.

September 25, 2015

Trauma is the leading cause of death in children from 6 months of age to young adulthood. In children with cardiac arrest, "trauma" should be considered among the H's and T's of underlying causes.

Chameides L, Samson RA, Schexnayder SM, Hazinski MF, eds. Pediatric Advanced Life Support: Provider Manual. First American Heart Association Printing; 2011.

September 24, 2015

ECMO may be beneficial for infants and children in cardiac arrest due to acute reversible conditions, especially with primary cardiac conditions.

Chameides L, Samson RA, Schexnayder SM, Hazinski MF, eds. Pediatric Advanced Life Support: Provider Manual. First American Heart Association Printing; 2011.

September 23, 2015

In those who are able to tolerate oral intake, oral potassium is preferred over IV. IV potassium should be closely monitored for infiltration. Those on infusion rates > 20 mEq/H should be on cardiac monitoring.

Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011.

September 22, 2015

While shellfish contain iodine, it is tropomyosin protein in the shellfish which causes the allergy. This protein has no cross-reactivity with contrast dye. Thus, individuals who are allergic to shellfish do not have an increased risk of having any allergic reaction to contrast dye as compared to those with any other allergy.

Schabelman E and Witting M. The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. J Emerg Med 2010; 39(5): 701.

September 21, 2015

During emergency intubations, transtracheal ultrasonography can be used to assess endotracheal tube placement before confirmation with capnography.

Gottlieb, M., et al. Can Transtracheal Ultrasonography Be Used to Verify Endotracheal Tube Placement? Annals of Emergency Medicine. http://dx.doi.org/10.1016/j.annemergmed.2015.02.023

September 20, 2015

Postoperative bleeding after tonsillectomy most commonly occurs on postoperative days 5-7, but significant bleeding can occur up to 2 weeks after surgery.

Amieva-Wang, N. Ewen. "Postoperative Tonsillectomy." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 205. Print.

September 19, 2015

Sphenopalatine nerve block with Buvipacaine failed to show a benefit compared to normal saline placebo in treating acute headache in the ED.

Schaffer JT, Hunter BR, Ball KM, Weaver CS. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial. Ann Emerg Med. 2015;65(5):503-10.

September 18, 2015

SJS/TEN frequently involve the conjunctiva and cornea, and can result in permanent scarring and blindness. Thus, all patients with SJS/TEN should undergo a fluorescein stain and acute ophthalmologic evaluation.

Gueudry J, Roujeau JC, Binaghi M, Soubrane G, Muraine M. Risk factors for the development of ocular complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Arch Dermatol 2009; 145(2): 157.

September 17, 2015

Subclavian central access is preferred over femoral for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy.

Hamilton HC, Foxcroft DR. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004084

September 16, 2015

Stones less than 5 mm in diameter will usually pass spontaneously, although it may require several weeks of conservative management. Conversely, 50% of stones larger than 5 mm require urologic intervention for removal, and those above 10 mm are very unlikely to pass unaided.

Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178:101-103.

September 15, 2015

The presenting complaints in rejection of the transplanted heart are typically arrhythmias or fatigue. If a heart transplant patient presents with an arrhythmia, rejection should be the leading differential until proven otherwise.

Tintinalli, J.E., Stapczynski, J.S., Ma, O.J., Cline, D.M., Cydulka, R.K., & Meckler, G.D. (2010). Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7th edition. New York: McGraw Hill, Medical Pub. Division.

September 14, 2015

Prophylactic antibiotic use in patients with cirrhosis and upper GI bleeding significantly reduced bacterial infections, and trended towards reduced mortality, rebleeding events, and length of stay.

Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FI, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD002907.

September 13, 2015

In acute digoxin toxicity, hyperkalemia is a predictor of poor outcomes.

Block BK, Cheung DS, Platts-Mills TF. First Aid for the Emergency Medicine Boards. New York, NY: McGraw-Hill; 2012. Chapter 6 Toxicology.

September 12, 2015

A false-positive FAST exam in blunt trauma can be due to massive volume resuscitation.

Slutzman JE, Arvold LA, Rempell JS, Stone MB, Kimberly HH. Positive FAST without hemoperitoneum due to fluid resuscitation in blunt trauma. J Emerg Med. 2014 Oct;47(4):427-9.

September 11, 2015

A systematic review did not find any evidence that Ketamine caused sustained changes in intracranial pressure, or an increase in mortality in patients with TBI.

Cohen L, Athaide V, Wickham ME, Doyle-waters MM, Rose NG, Hohl CM. The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review. Ann Emerg Med. 2015;65(1):43-51.e2.2)

September 10, 2015

The use of alpha blockers in adult patients appears to hasten the passage of ureteral stones with minor side effects.

Welch, JL, et al. Do ?-Blockers Expedite Ureteral Stone Passage? Annals of Emergency Medicine.

September 09, 2015

There is a higher incidence of cases of intussusception in the fall and spring seasons. A common hypothesis is that viral infections cause lymphoid hyperplasia and then serve as a lead point for intussusception.

Amieva-Wang, N. Ewen. "Intussusception." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 302-4. Print.

September 08, 2015

When optimizing preoxygenation to prepare for intubation, elevate the head of the bed. If there is concern for a cervical spine injury, place the bed in reverse Trendelenburg.

Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75

September 07, 2015

Patients treated in emergency department hallways contribute to lower emergency department satisfaction.

Stiffler KA, Wilber ST. Hallway Patients Reduce Overall Emergency Department Satisfaction. J Emerg Med. 2015 Jun 14. pii: S0736-4679(14)00396-5.

September 06, 2015

Staph aureus pneumonia can occur after a viral illness in patients who are otherwise healthy.

Emerman CL, Anderson E, Cline DM. Emerman C.L., Anderson E, Cline D.M. Emerman, Charles L., et al.Community-Acquired Pneumonia, Aspiration Pneumonia, and Noninfectious Pulmonary Infiltrates. 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. Judith E. Tintinalli, et al.eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915396. Accessed July 15, 2015.

September 05, 2015

Morphine, codeine, and hydrocodone are three opioids that have not been previously associated with precipitating serotonin syndrome.

Herbert, Mel, and Paul Jhun. Annals of Emergency Medicine - Serotonin Syndrome. N.d. EMRAP. Web. 5 July 2015.

September 04, 2015

The two most common causes of postpartum hemorrhage are uterine atony and retained products of conception.

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

September 03, 2015

In patients with a moderate to high pretest probability of acute cardiogenic pulmonary edema, sonographic B-lines help to confirm the diagnosis. In patients with a low pretest probability, a normal lung ultrasonographic result nearly excludes cardiogenic pulmonary edema.

Gottlieb, M., et al. What Is the Clinical Utility of Bedside Ultrasonography in the Diagnosis of Acute Cardiogenic Pulmonary Edema in the Undifferentiated Dyspneic Patient? Annals of Emergency Medicine.

September 02, 2015

Homans sign is only 10-54% sensitive and 39-89% specific for detecting lower extremity DVT.

McGee, Steven R. (2012). Evidence-Based Physical Diagnosis, 3e. Philadelphia, PA: Elsevier-Saunders.

September 01, 2015

Child abuse and neglect is underrecognized and underreported in Emergency Departments. The desire to believe caregivers and personal biases play a large role in neglecting abuse suspicion, and it is paramount to be aware of possible child abuse when the clinical scenario presents itself.

iyyagura G, Gawel M, Koziel JR. "Barriers and Facilitators to Detecting Child Abuse and Neglect in General Emergency Departments". American College of Emergency Physicians; Annals of Emergency Medicine. Ann Emerg Med. 2015 Jul 29.