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American Academy of Emergency Medicine

Fact of the Day - October 2015

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

October 31, 2015

Treatment of BPPV using canalith-repositioning maneuvers is effective in more than 90% of patients.

Fife TD, von Brevern M. Benign Paroxysmal Positional Vertigo in the Acute Care Setting. Neurol Clin. August 2015; 33(3):601-617.

October 30, 2015

Adult incisors will have small ridges (called mamelons) along the cutting edge as they erupt from the gum. These protuberances are quickly worn down from use but can be used to distinguish an adult tooth from a primary tooth.

Kumar PS. Dental Anatomy and Tooth Morphology. Daryaganj, New Delhi: Jaypee Brothers Medical Publishers; 2007. Page 76.

October 29, 2015

Atropine is ineffective in the denervated transplanted heart, thus in cases of symptomatic bradycardia, an isoproterenol infusion at 1-4mcg/min is most appropriate.

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.

October 28, 2015

The differential diagnosis for T-wave inversion includes myocardial infarction, myocarditis, old pericarditis, myocardial contusion, and digoxin toxicity.

Mattu, Amal. Cardiology Corner - Pericarditis. N.d. EMRAP. Web 5 July 2015.

October 27, 2015

Mortality caused by pulmonary embolism can be appropriately assessed by CT showing right-sided ventricular dysfunction. Right-sided ventricular dysfunction assessed by computed tomography (CT) is associated with all-cause short-term mortality and more strongly associated with mortality caused by pulmonary embolism.

West, JR., Friedman, BW. et al. Can Computed Tomography-Assessed Right-Sided Ventricular Dysfunction Predict Mortality in Hemodynamically Stable Pulmonary Embolism? Annals of Emergency Medicine. http://dx.doi.org/10.1016/j.annemergmed.2015.04.023

October 26, 2015

Healthy participants were able to tolerate 15L/min by nasal cannula for 10 minutes without significant discomfort, suggesting that higher flow O2 by nasal cannula is acceptable to use during the peri- intubation period.

Brainard A, Chuang D, Zeng I, Larkin GL. A randomized trial on subject tolerance and the adverse effects associated with higher- versus lower-flow oxygen through a standard nasal cannula. Ann Emerg Med. 2015;65(4):356-61.

October 25, 2015

Ventricular tachyarrhythmias immediately after cocaine use result from the local anesthetic (sodium channel) effect on the myocardium and may respond to sodium bicarbonate therapy in addition to standard therapies (i.e. lidocaine).

Zane RD, Kosowsky, JM, Pocket Emergency Medicine Third Edition. Philadelphia: Wolters Kluwer; 2015: 1-11

October 24, 2015

Neurological causes of cardiac arrest include subarachnoid hemorrhage, intracerebral hemorrhage, epileptic seizure and ischemic strokes.

Hubner P, Meron G, Kurkciyan I, Weiser C, Wallmuller C, Stockl M, Schober A, van Tulder R, Sterz F. Neurologic causes of cardiac arrest and outcomes. J Emerg Med. 2014 Dec

October 23, 2015

ASA 162-325 mg PO (crushed/chewed) should be given as early as possible in patients with UA/NSTEMI

VA Cooperative Study, NEJM 1983;309:396; NEJM 1988;319(17):1105

October 22, 2015

The characteristic barking cough of croup is often not heard in severe cases with impending respiratory failure due to weak respiratory effort caused by severe hypoxemia and hypercarbia.

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

October 21, 2015

In patients with low back pain include age greater than 70, any trauma with age greater than 50, chronic steroid use, osteoporosis, and symptoms of cancer.

Zane RD, Kosowsky, JM, Pocket Emergency Medicine Third Edition. Philadelphia: Wolters Kluwer; 2015: 12-2

October 20, 2015

The addition of intravenous magnesium does not shorten length of stay, reduce opioid use or improve quality of life in children hospitalized for sickle cell pain crisis.

Brousseau JP, Scott JP, Darbari DS. "A multi-center randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children". American Society of Hematology. Blood. 2015 Jul 31.

October 19, 2015

Ondansetron therapy decreases the risk of persistent vomiting, the use of intravenous fluid, and hospital admissions in children with vomiting due to gastroenteritis.?

Decamp LR et. al. Use of Antiemetic Agents in Acute Gastroenteritis: A systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2008 Sep;162(9):858-65.

October 18, 2015

Formal fluid resuscitation should be initiated for any adult or pediatric patient with greater than 20 percent total body surface area (TBSA). If less than 20 percent TBSA, maintenance fluid alone is appropriate.

Pham TN, Cancio LC, Gibran NS. American Burn Association practice guidelines burn shock resuscitation. J Burn Care Res 2008; 29(1): 257.

October 17, 2015

Bedrest after lumbar puncture does not reduce the risk of post lumbar puncture headache.

Carbaat PA, et al. Lumbar puncture headache: controlled study on the preventive effect of 24 hours' bed rest. Lancet. 1981 Nov 21;2(8256):1133-5.

October 16, 2015

Ketofol 1:1 and Ketofol 1:4 did not show any apparent benefit over propofol for deep procedural sedation.

Miner JR, Moore JC, Austad EJ, Plummer D, Hubbard L, Gray RO. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med. 2015;65(5):479-488.e2.

October 15, 2015

Kawasaki Disease is the most common cause of acquired heart disease in children. Coronary artery aneurysm can occur in 25% of untreated patients and with treatment, the occurrence of coronary artery aneurysm drops to 4-6%.

Amieva-Wang, N. Ewen. "Vasculitis Syndromes." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 380-386. Print.

October 14, 2015

Sepsis is the leading cause of death in children with sickle cell disease. They are at high risk for serious bacterial infection as they have absent splenic function, defects in the alternate complement pathways and low nitric oxide bioavailability.

Amieva-Wang, N. Ewen. "Sickle Cell Emergencies." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 360-67. Print.

October 13, 2015

Corticosteroids have demonstrated no clear benefit for patients in the ED with musculoskeletal lower back pain.

Eskin B, Shih RD, Fiesseler FW, Walsh BW, Allegra JR, Silverman ME, Cochrane DG, Stuhlmiller DF, Hung OL, Troncoso A, Calello DP. Prednisone for emergency department low back pain: a randomized controlled trial. J Emerg Med. 2014 Jul;47(1):65-70.

October 12, 2015

A comparison of the effect on nightly cough and sleep quality in children and their parents demonstrated that receiving a 2.5-mL dose of honey before sleep has a more alleviating effect on URI-induced cough compared with dextromethorphan and diphenhydramine doses.

Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010 Jul;16(7):787-93.

October 11, 2015

Monteggia's fracture is a fracture of the proximal ulna with distal dislocation of the radial head at the elbow.

Streubel P, Pesantez R. Diaphyseal fractures of the radius and ulna. In: Rockwood and Green's Fractures in Adults, 8th ed, Court-Brown CM, Heckman JD, McQueen MM, et al. (Eds), Wolters Kluwer Health, Philadelphia 2014. p.1121.

October 10, 2015

Hepatic encephalopathy is difficult to recognize in children. Severe coagulopathy is a more universal sign of acute liver failure in children. Unless the patient requires a life-saving invasive procedure or has a life-threatening hemorrhage, the coagulopathy should not be corrected.

Amieva-Wang, N. Ewen. "Fulminant hepatic failure." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 308-10. Print.

October 09, 2015

Administration of intravenous cobinamide showed no difference in time to return of spontaneous breathing compared to intravenous hydroxocobalamin in cyanide exposed swine models. However, cobinamide showed equal response at one fifth the dose of hydroxocobalamin.

Bebarta VS, Tanen DA, Boudreau S, et al. Intravenous cobinamide versus hydroxocobalamin for acute treatment of severe cyanide poisoning in a swine (Sus scrofa) model. Ann Emerg Med. 2014;64(6):612-9.

October 08, 2015

Isopropyl alcohol poisoning causes two times the CNS depression of ethanol poisoning. Its breakdown product is acetone, which has a half-life of 22 hours and accounts for the prolonged duration of depressed mental status. In severe cases it is associated with gastritis causing GI bleeding and hypotension.

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

October 07, 2015

Bedside ultrasound in pediatric patients can be helpful to assess volume status, fractures, and aiding in performance of lumbar punctures.

Levy JA, Bachur RG. Bedside ultrasound in the pediatric emergency department. Curr Opin Pediatr. 2008 Jun;20(3):235-42. doi: 10.1097/MOP.0b013e3282ff1317. Review.

October 06, 2015

The two most time-sensitive eye injuries are central retinal occlusion and chemical burns to the eyes.

Markovchick, Vincent J., Peter T. Pons, and Katherine M. Bakes. "Chapter 84. Traumatic Ophthalmologic Emergencies." Emergency Medicine Secrets. 5th ed. St. Louis, MO: Elsevier/Mosby, 2011. 587. Print.

October 05, 2015

Point of care ultrasonography is a useful tool in determining adequate fracture realignment in pediatric patients with forearm fractures. However, inadequate alignment based on ultrasonography should be followed with additional imaging.

Dubrovsky AS, Kempinska A, Bank I, Mok E. Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures. Ann Emerg Med. 2015;65(3):260-5.

October 04, 2015

MRSA is the primary pathogen in more than 50% of cases of impetigo. For localized infection, topical mupirocin can be used for a 1-2 week course.

Amieva-Wang, N. Ewen. "Skin and soft tissue infections." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 449-53. Print.

October 03, 2015

The straight leg raise test is performed by passively flexing the hip 30-70 degrees, and is positive only when pain radiates past the knee. This is a relatively sensitive test for L5 or S1 radiculopathy.

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

October 02, 2015

TXA is a safe and effective method to treat anterior epistaxis of idiopathic origin.

Zahad R, Moharamzadeh P, Alizadeharasi S, et al. A New and Rapid Method for Epistaxis Treatment Using Injectable Form of Tranexamic Acid Topically; A Randomized Controlled Trial. Am J Emerg Med 2013; 31(9): 1389-92.

October 01, 2015

Pressures of 60 mmHg for one hour on the skin surface of dogs can lead to the development of a Pressure Ulcer. Studies of able bodied individuals strapped to a backboard reveal pressures in excess of 260 mmHg.

Ohio Department of Public Safety. Relationship Between Time on a Backboard and Pressure Ulcer Development in Persons with Traumatic Spinal Cord Injuries.