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American Academy of Emergency Medicine

Fact of the Day - January 2016

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

January 13, 2016

Five clinical prediction rules to predict early all-cause mortality related to pulmonary embolism have sensitivities greater than 88%, but only three of these rules are supported by a high level of evidence. The simplified Pulmonary Embolism Severity Index appears to have the greatest potential, given its relatively higher sensitivity and ease of use.

Long BJ, Koyfmann A"Do Clinical Prediction Rules for Acute Pulmonary Embolism Have Sufficient Sensitivity to Identify Patients at Very Low Risk of Death?". American College of Emergency Physicians. Annals of Emergency Medicine. Chest. 2015;147:1043-1062.

January 12, 2016

When compared to trending troponin levels to help rule out AMI, a single 4-hour high-sensitivity troponin I (hs-cTnI) did not prove to be a safe measure to accurately rule-out AMI.

Pickering JW, Young JM, George P. "The utility of presentation and 4-hour high sensitivity troponin I to rule-out acute myocardial infarction in the emergency department". Clin Biochem. Pub Med; 2015 Jul 28.

January 11, 2016

Chlamydia trachomatis is the most common sexually transmitted infection among adolescents. The current recommended treatment is Azithromycin 1g PO once.

Amieva-Wang, N. Ewen. "Sexually Transmitted diseases." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 443-48. Print.

January 10, 2016

90% of children < 2 years old presenting with appendicitis will have perforation at presentation.

Zane RD, Kosowsky, JM, Pocket Emergency Medicine Third Edition. Philadelphia: Wolters Kluwer; 2015: 14-2

January 09, 2016

Acute bacterial conjunctivitis is frequently a self-limiting condition, but the use of antibiotics is associated with significantly improved rates of clinical and microbiological remission.

Sheik A, Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2006;(2):CD001211. PMID: 16625540.

January 08, 2016

If defibrillation is indicated in a child and no pediatric equipment is available, use a standard adult AED with adult pad-cable system. It is better to shock with a high dose than not shock at all.

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

January 07, 2016

Galeazzi's fracture is a fracture of the distal radius with a distal radioulnar dislocation at the wrist

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.

January 06, 2016

A retrospective chart review showed that systemic coagulopathy and thrombocytopenia are uncommon with Agkistrodon (copperhead) envenomation, suggesting that serial coagulation profiles may not be necessary in confirmed cases.

De bastos M, Barreto SM, Caiafa JS, Bogutchi T, Rezende SM. Assessment of characteristics associated with pharmacologic thromboprophylaxis use in hospitalized patients: a cohort study of 10,016 patients. Blood Coagul Fibrinolysis. 2013;24(7):691-7.

January 05, 2016

In otherwise healthy adults, Streptococcus pneumonia and Legionella cause the most severe community acquired pneumonia.

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.

January 04, 2016

Without adverse effects on vitals signs, Ketamine can serve as a very efficient route of sedation for overly-agitated patients in the emergency department after more conservative routes have proven inadequate.

Hopper A, Vilke G, Castillo E, Campillo A, Davie T, Wilson M. Ketamine Use For Acute Agitation In The Emergency Department. Dept of Emergency Medicine, UCSD. Pharmacology in Emergency Medicine; The Journal of Emergency Medicine, Vol. 48, No. 6, pp. 712-719, 2015

January 03, 2016

Substances that will not respond to activated charcoal include metals, caustics, hydrocarbons, and alcohols.

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

January 02, 2016

Classic heat stroke presents with the triad of altered mental status, hyperthermia, and anhidrosis.

Amieva-Wang, N. Ewen. "Heat-related illness." A Practical Guide to Pediatric Emergency Medicine: Caring for Children in the Emergency Department. Cambridge: Cambridge UP, 2010. 234-36. Print.

January 01, 2016

JVD has a likelihood ratio of 5.1 for diagnosing acute diastolic heart failure; greater than the ratio for an S3, rales, any murmur, or lower extremity edema.

Zane RD, Kosowsky, JM, Pocket Emergency Medicine Third Edition. Philadelphia: Wolters Kluwer; 2015: 1-22