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American Academy of Emergency Medicine

Fact of the Day - December 2015

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

December 31, 2015

Acidification of 1 liter of water by adding the juice from 1 lime can be sufficient to kill Vibrio cholerae depending on the species of lime (those with a pH < 2.5).

Iserson, Kenneth V. "Chapter 32. Infectious Diseases." Improvised Medicine: Providing Care in Extreme Environments . Ed. Kenneth V. Iserson. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 5 Jul. 2015.

December 30, 2015

Because the half-life of carboxyhemoglobin in inversely related to the pO2, treatment should begin with 100% O2 supplementation. Hyperbaric oxygen may help prevent delayed neurological sequelae.

Rosen, Peter, John A. Marx, Robert S. Hockberger, Ron M. Walls, and James Adams. "Chapter 159. Inhaled Toxins - Carbon Monoxide." Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier, 2006. 2042. Print.

December 29, 2015

Ultrasound is highly specific and moderately sensitive in the identification of retained soft tissue foreign bodies; however, studies to date have a high degree of heterogeneity and a high risk of bias.

Davis, J. et al. Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systemic Review and Meta- analysis. Academic Emergency Medicine. 2015;22:77-787. doi: 10.1111/acem.12714.

December 28, 2015

Although historically a diagnosis of appendicitis has required surgery and hospitalization, there is a growing body of literature that treatment with only antibiotics may be a reasonable choice for certain adult patients.

Park, HC et al. The outcome of antibiotic therapy for uncomplicated appendicitis with diameters <10mm. Int J Surg. 2014; 12(9):897-900.

December 27, 2015

CPR in children after traumatic cardiac arrest has been shown to yield a better outcome than in adults with traumatic cardiac arrest. Resuscitation in the ED is associated with better neurological outcomes compared to an adult cohort.

Zwingmann J, Lefering R, Bayer J. "Outcome and risk factors in children after traumatic cardiac arrest and successful resuscitation". Resuscitation. 2015 Jul 29.

December 26, 2015

The NEXUS criteria are 99.6% sensitive and 12.9% specific for significant cervical spine injuries in adults.

Markovchick, Vincent J., Peter T. Pons, and Katherine M. Bakes. "Top 100 Secrets." Emergency Medicine Secrets. 5th ed. St. Louis, MO: Elsevier/Mosby, 2011. 6. Print.

December 25, 2015

Catamenial pneumothorax is a rare clinical condition in which women of reproductive age develop recurrent, spontaneous pneumothoraces in conjunction with their menstrual cycle.

Visouli AN et al. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. J Thorac Dis. 2012 Nov;4 Suppl 1:17-31.

December 24, 2015

High Altitude Cerebral Edema (HACE) often occurs concurrently in cases of High Altitude Pulmonary edema (HAPE). Autopsies performed on individuals who died of HAPE demonstrated that 50% of these individuals also had HACE present. A retrospective study suggested the same but found the incidence to be closer to 14% in those diagnosed with HAPE.

1. Hultgren H.N., Honigman B., Theis K.,& Nicholas D. (1996). High-altitude pulmonary edema at a ski resort. West J Med 164(3): 222-227. 2. Hackett P.H. & Roach R.C. (2004). High altitude cerebral edema. High Altitude Medicine & Biology 5(2): 136-146

December 23, 2015

Triple point of care ultrasound (lung, heart and leg vein) can be considered in evaluating for pulmonary embolism in certain populations, such as those with a contrast allergy, severe renal insufficiency, or during pregnancy.

Squizzato A, Galli L, Gerdes VE. Point-of-care ultrasound in the diagnosis of pulmonary embolism. Crit Ultrasound J. 2015 May 27;7:7. doi: 10.1186/s13089-015-0025-5. eCollection 2015. Review.

December 22, 2015

The main independent predictors of mortality in patients with flail chest were reported to be increased age and injury severity score.

Battle, CE, Evans, PA. Predictors of Mortality in Patients with Flail Chest: A Systematic Review. Emergency Medicine Journal: EMJ 2015 Jul 17.

December 21, 2015

A CT scan for appendicitis is "negative" only if the entire appendix has been visualized and is normal.

Markovchick, Vincent J., Peter T. Pons, and Katherine M. Bakes. "Top 100 Secrets." Emergency Medicine Secrets. 5th ed. St. Louis, MO: Elsevier/Mosby, 2011. 4. Print.

December 20, 2015

Out-of-hospital shock has a mortality rate that exceeds that of other high-risk conditions such as ST-segment elevation myocardial infarction. ED hypotension is a scenario associated with a mortality rate of more than 10%, and careful consideration should be given to the baseline health, comorbidities, and clinical presentation of the patient before assuming any measurement of hypotension as an unfounded finding.

Holler JG, Bech CN, Henriksen DP, et al. Nontraumatic hypotension and shock in the emergency department and the prehospital setting: prevalence, etiology, and mortality: a systematic review. American College of Emergency Physicians; Annals of Emergency Medicine.PLoS One. 2015;10:e0119331

December 19, 2015

Acute mountain sickness presents with the onset of headache with either gastrointestinal upset, weakness, dizziness, or difficulty sleeping with gain of altitude.

Rosen, Peter, John A. Marx, Robert S. Hockberger, Ron M. Walls, and James Adams. "Chapter 144. High-Altitude Medicine - Acute Mountain Sickness." Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier, 2006. 1932. Print.

December 18, 2015

Drug packets and sustained-release medications are common indications for whole-bowel irrigation.

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

December 17, 2015

The results of a 2015 randomized trial suggest that peanut consumption in infancy helps prevent a peanut allergy later in life.

Du Toit G et al. Randomized trial of peanut consumption in infants at risk of peanut allergy. New England Journal of Medicine DOI: 10.1056/NEJMoa1414850 (2015).

December 16, 2015

Ecallantide therapy for patients with mild to moderate ACEI angioedema did not provide a statistically significant benefit to patients.

Lewis LM, Graffeo C, Crosley P, et al. Ecallantide for the acute treatment of angiotensin-converting enzyme inhibitor-induced angioedema: a multicenter, randomized, controlled trial. Ann Emerg Med. 2015;65(2):204-13.

December 15, 2015

Systemic causes of abdominal pain include diabetic ketoacidosis, alcoholic ketoacidosis, uremia, sickle cell disease, and porphyria.

Marx, John; Walls, Ron; Hockberger, Robert (2013-08-01). Rosen's Emergency Medicine - Concepts and Clinical Practice (Rosens Emergency Medicine Concepts and Clinical Practice) (Kindle Locations 15929-15933). Elsevier Health Sciences. Kindle Edition.

December 14, 2015

Fever, abdominal pain, and obstructive jaundice suggest ascending cholangitis.

Marx, John; Walls, Ron; Hockberger, Robert (2013-08-01). Rosen's Emergency Medicine - Concepts and Clinical Practice (Rosens Emergency Medicine Concepts and Clinical Practice) (Kindle Locations 16377-16378). Elsevier Health Sciences. Kindle Edition.

December 13, 2015

Consider massive PE (and potentially thrombolytics) in unexplained PEA arrest.

Zane RD, Kosowsky, JM, Pocket Emergency Medicine Third Edition. Philadelphia: Wolters Kluwer; 2015: 1-21

December 12, 2015

Intraosseeous lines are contraindicated in bones that have had previous joint surgery.

Wayne, Marvin A. "Intraosseous vascular access in emergency medicine." Eur Crit Care Emerg Med 1 (2009): 33-36

December 11, 2015

Cost of medical care was lower for low-risk VTE patients discharged immediately from the ED with Rivaroxaban therapy compared with patients treated with LMWH-warfarin.

Kahler, ZP, Beam DM, Kline, JA. Cost of Treating Venous Thromboembolism with Heparin and Warfarin vs Home Treatment with Rivaroxaban. Academic Emergency Medicine. 2015;22:796-802. doi: 10.1111/acem.12713.

December 10, 2015

For patients with sub-massive pulmonary embolism (hemodynamically stable, but with right ventricular dysfunction), thrombolytics were found to decrease all-cause mortality greater than anti-coagulation.

Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, Kumbhani DJ, Mukherjee D, Jaff MR, Giri J. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014 Jun 18;311(23):2414-21.

December 09, 2015

Performance of an abdominal CT was associated with fewer 30-day revisits.

Patterson, BW, Venkatesh AK, AlKhawam, L, Pang, PS. Abdominal CT Utilization and 30-day Revisitation in Emergency Department Patients Presenting With Abdominal Pain. Academic Emergency Medicine 105; 22; 803-810. doi: 10.1111/acem.12698

December 08, 2015

Anemic children may not appear cyanotic despite significant hypoxemia, as the degree of cyanosis is directly related to the child's hemoglobin concentration.

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

December 07, 2015

Any medication administered via IV can be given IO, including vasoactive drugs.

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

December 06, 2015

Consider acute vitamin A intoxication in the differential diagnosis for patients with headache, flushing, desquamation, and digestive symptoms of unknown etiology.

"Vitamin A (retinol) Safety." Drugs and Supplements. Mayo Clinic, 1 Nov. 2013. Web. 05 July 2015.

December 05, 2015

Grunting in the context of respiratory distress is a compensatory mechanism used by infants and children to maintain positive airway pressure. This is achieved by producing early glottic closure during expiration.

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

December 04, 2015

Vasopressor usage in ATCCS (Acute Traumatic Central Cord Syndrome) patients is associated with complication rates that are similar to the reported literature for SCI (Spinal Cord Injury). Careful consideration of the risks should be made before administering dopamine in the context of ATCCS in patients over 55 years.

Readdy WJ, Whetstone WD, Ferguson AR, Talbott JF. "Complications and outcomes of vasopressor usage in acute traumatic central cord syndrome". Journal of Neurosurgery: Spine. Jul 2015 (2): 1-7.

December 03, 2015

D-dimer is likely to be elevated in pregnancy; however, in a patient with low pretest probability a negative D-dimer is still reliably negative.

Chan WS, Chunilal S, Lee A, et al. A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. Ann Intern Med 2007;147:165-70.

December 02, 2015

Evidence is inadequate to support the use of procalcitonin as a test to rule in or rule out the diagnosis of endocarditis.

Yu, CW, Juan LI, Hsu SC, et al. Role of Procalcitonin in the Diagnosis of Infective Endocarditis: A Meta-Analysis. Am J Emerg Med. 2013;31:935-941.

December 01, 2015

Subclavian vein catheterization accounts for 25% of iatrogenic pneumothoraces. Chest X-ray should follow catheter placement. However, presentation of pneumothorax may be delayed post-procedure.

McCaskill RL. Chapter 32. Spontaneous and Iatrogenic Pneumothorax. In: Cline DM, Ma O, Cydulka RK, Meckler GD, Handel DA, Thomas SH. eds. Tintinalli's Emergency Medicine Manual, 7e. New York, NY: McGraw-Hill; 2012.