Category: Endocrine
Keywords: Cushing Syndrome (PubMed Search)
Posted: 8/9/2009 by Michael Bond, MD
(Updated: 9/5/2009)
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Cushing Syndrome
The most common cause of Cushing syndrome is the use of exogenous glucocorticoids, and it is rarer to have a problem with the hypothalamic-pituitary-adrenal axis.
These patients can present with:
For the emergency department we need to be worried about those on chronic steroids that can not increase their native steroid production in a time of stress which will lead them to adrenal crisis.
Pearls for those with Cushing Syndrome:
Category: Toxicology
Keywords: Menthol, camphor, vicks, seizure (PubMed Search)
Posted: 8/6/2009 by Ellen Lemkin, MD, PharmD
(Updated: 4/24/2024)
Click here to contact Ellen Lemkin, MD, PharmD
Vicks VapoRub Toxicity
With the removal of OTC product indications for children under the age of 2 for cough and colds, more parents are turning to other agents such as Vicks VapoRub for the relief of cough and cold symptoms. Unfortunately these agents are also associated with toxicities and the potential exists for an increased number of poisonings. The primary components of these agents are:
Menthol is used to relieve symptoms of chest congestion. There is NO data to support efficacy, and paradoxically, studies have indicated increased airflow resistance with application. There is a case report of an 18 month old who developed respiratory distress after application. Symptoms associated with overdose, or inappropriate route (mucosal, oral) are:
Camphor in products with higher concentrations such as Campho-phenique can cause additional toxicity with effects:
Treatment for both is supportive.
"Vicks VapoRub Safety in Children" Pharmacists Letter: Detail Document 250306, March 2009
Category: Neurology
Keywords: pml, progressive multifocal leukoencephalopathy, HIV, AIDS, opportunistic infections, demyelinating diseases (PubMed Search)
Posted: 8/5/2009 by Aisha Liferidge, MD
(Updated: 4/24/2024)
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Category: Critical Care
Posted: 8/4/2009 by Mike Winters, MD
(Updated: 4/24/2024)
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Antibiotic Dosing in the Critically Ill Septic Patient
Pea F, Viale P. Bench to bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter? Crit Care 2009;13:214.
Category: Vascular
Posted: 8/3/2009 by Rob Rogers, MD
(Updated: 4/24/2024)
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New Antihypertensive agent coming our way...
Well, we have nitroprusside, labetalol, nicardipine, fenoldopam, etc. Say hello to a new drug that is "reported" to be a great drug for ED patients with severe hypertension (emergencies)....Clevipidine (Cleviprex).
Clevidipine is an ultrashort acting calcium channel blocker that has been found to be a powerful antihypertensive medication.
Unique properties of the drug:
Remains to be seen if this drug will play in a role in the treatment of our severely hypertensive patients....stay tuned...
Category: Geriatrics
Keywords: elderly, dehydration (PubMed Search)
Posted: 8/2/2009 by Amal Mattu, MD
(Updated: 4/24/2024)
Click here to contact Amal Mattu, MD
Hypovolemia is very common in the ederly for two reasons:
1. The elderly have a decreased thirst response...in other words, it takes longer for them to develop thirst in the setting of dehydration.
2. The elderly have a decreased renal vasopressin response to hypovolemia.
From a treatment standpoint, one should always assume an elderly patient is hypovolemic. Hydration is incredibly important during resuscitation of the elderly patient.
Category: Orthopedics
Keywords: Monteggia's Fracture (PubMed Search)
Posted: 8/1/2009 by Michael Bond, MD
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Monteggia's Fracture
Wheeless' Textbook of Orthopaedics http://www.wheelessonline.com/ortho/monteggias_fracture
Category: Pediatrics
Posted: 8/1/2009 by Rose Chasm, MD
(Updated: 4/24/2024)
Click here to contact Rose Chasm, MD
Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med. 1995;149:36-39
Macpherson RI, Hill JG, Otherson HB, Tagge EP, Smith CD. Esophageal foreign bodies in children: diagnosis, treatment, and complications. AJR Am J Roentgenol. 1996;166:919-924
Category: Toxicology
Keywords: lidocaine (PubMed Search)
Posted: 7/30/2009 by Fermin Barrueto, MD
(Updated: 4/24/2024)
Click here to contact Fermin Barrueto, MD
To feed of off Dr. Liferidge's last pearl - a few more points relevant to your Emergency Department practice:
1) Hess GP, Walson PD: Seizures secondary to oral viscous lidocaine. Ann Emerg Med 1988; 17:725-272.
2) Rothstein P, Dornbusch J, Shaywitz B: Prolonged seizures associated with the use of viscous lidocaine. J Pediatr 1982; 101:461-463.
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Category: Neurology
Keywords: lidocaine, lidocaine toxicity, seizure (PubMed Search)
Posted: 7/30/2009 by Aisha Liferidge, MD
(Updated: 4/24/2024)
Click here to contact Aisha Liferidge, MD
Category: Critical Care
Posted: 7/28/2009 by Mike Winters, MD
(Updated: 4/24/2024)
Click here to contact Mike Winters, MD
Internal Jugular CVC Placement and Posterior Wall Penetration
Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med 2009;37:2345-9.
Category: Airway Management
Keywords: Upper GI Bleed, Fistula (PubMed Search)
Posted: 7/27/2009 by Rob Rogers, MD
(Updated: 4/24/2024)
Click here to contact Rob Rogers, MD
Aortoenteric Fistula (AEF)-Beware the Upper GI Bleed!
Important points about AEF:
Pearl: Suspect a aortoenteric fistula in any patient with a prior AAA repair who presents with an upper GI bleed (may also be lower GI bleed)
Category: Geriatrics
Keywords: mortality, acute coronary syndromes, prognosis (PubMed Search)
Posted: 7/26/2009 by Amal Mattu, MD
(Updated: 4/24/2024)
Click here to contact Amal Mattu, MD
The elderly are at tremendous risk of death after MI, in no small part because we tend to undertreat them. The 30-day mortality rate after MI in patients < 65 is 3%.
In patients 65-74, the 30-day mortality is 10%.
In patients 75-84, the 30-day mortality is 20%.
In patients > 85, the 30-day mortality is 30%.
Be vigilant and be aggressive with elderly patients. Their early management has a tremendous bearing on their later outcomes.
Category: Obstetrics & Gynecology
Keywords: postpartum, headache (PubMed Search)
Posted: 7/25/2009 by Michael Bond, MD
(Updated: 7/26/2009)
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Postpartum Headaches:
Category: Pediatrics
Posted: 7/25/2009 by Rose Chasm, MD
(Updated: 4/24/2024)
Click here to contact Rose Chasm, MD
Haddad GG. Primary ciliary dyskinesia. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB SaundersCo; 2000:1327-1328
Category: Toxicology
Keywords: ciguatera toxin, marine toxin (PubMed Search)
Posted: 7/23/2009 by Fermin Barrueto, MD
(Updated: 4/24/2024)
Click here to contact Fermin Barrueto, MD
Ciguatera
0907232233_ciguatera.gif (13 Kb)
Category: Neurology
Keywords: dysphagia, stroke, dysarthria, gag reflex (PubMed Search)
Posted: 7/22/2009 by Aisha Liferidge, MD
(Updated: 4/24/2024)
Click here to contact Aisha Liferidge, MD
Category: Critical Care
Posted: 7/21/2009 by Mike Winters, MD
(Updated: 4/24/2024)
Click here to contact Mike Winters, MD
Dexmedetomidine and the Critically Ill
Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.
Category: Orthopedics
Keywords: jones fracture,foot fracture,malunion (PubMed Search)
Posted: 6/21/2009 by Dan Lemkin, MD, MS
(Emailed: 7/18/2009)
(Updated: 7/18/2009)
Click here to contact Dan Lemkin, MD, MS
Jones fracture
Presented with persistant foot pain from
Jones fracture malunion.
http://www.wheelessonline.com/ortho/jones_fracture
http://www.wheelessonline.com/ortho/avulsion_frx_of_base_of_5th_metatarsal
Category: Pediatrics
Posted: 7/17/2009 by Rose Chasm, MD
(Updated: 4/24/2024)
Click here to contact Rose Chasm, MD
Baskin MN. Injury-knee. In:Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:339-347
Staheli LT. Hip. In: Fundamentals of Pediatric Ortopoedics. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998:68-71.