Category: Endocrine
Keywords: hyperparathyroidism, hypercalcemia (PubMed Search)
Posted: 8/29/2009 by Michael Bond, MD
(Updated: 9/5/2009)
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Hyperparathyroidism results in elevated PTH and typically results in elevated calcium levels (hypercalcemia).
Though most cases are asymptomatic, symptomatic patients can present with:
Treatment options to be discussed next week....Stay tuned.
Category: Toxicology
Posted: 8/27/2009 by Fermin Barrueto
(Updated: 2/15/2025)
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Valproic Acid (Depakote)
Category: Pediatrics
Posted: 8/26/2009 by Rose Chasm, MD
(Updated: 2/15/2025)
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Haslam RH. Seizures in childhood. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co, 2000;1813-1829
Sabo-Graham T, Seay AR. Managemnt of status epilepticus in children. Pediatr Rev. 1998;19:306-309
Category: Neurology
Keywords: seizure, first-time seizure, new onset seizure (PubMed Search)
Posted: 8/26/2009 by Aisha Liferidge, MD
(Updated: 2/15/2025)
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Category: Critical Care
Posted: 8/25/2009 by Mike Winters, MBA, MD
(Updated: 2/15/2025)
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Pulse Pressure Variation and Volume Responsiveness
Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature. Crit Care Med 2009;37(9):2642-7.
Category: Vascular
Keywords: AAA (PubMed Search)
Posted: 8/24/2009 by Rob Rogers, MD
(Updated: 2/15/2025)
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Unusual Presentations of AAA
Many unusual presentations of AAA have been reported in the literature and include:
One more note on the whole urge to deficate thing: any thing that leads to hemoperitoneum may cause this strange complaint (ruptured AAA, ruptured ectopic pregnancy).
Category: Geriatrics
Keywords: hyperthermia, heat stroke (PubMed Search)
Posted: 8/23/2009 by Amal Mattu, MD
(Updated: 2/15/2025)
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Be wary of the limitations of correlating a temperature with infection in the elderly:
1. The elderly are 3-4x more likely to develop hypothermia in response to serious infections. Never rule out a serious infection simply based on a low or normal body temperature.
2. The elderly take longer to mount a fever than younger patients.
3. The elderly have a slightly lower body temperature at baseline, possibly 1 degree lower. As a result, "fever" in the elderly is sometimes defined as 99.5 degrees rather than the traditional 100 or 100.4 used in younger patients.
Category: Pediatrics
Keywords: Pediatrics, hypertension, encephalopathy (PubMed Search)
Posted: 8/22/2009 by Reginald Brown, MD
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Hypertensive encephalopathy is generally seen in children with renal disease, e.g. acute glomerulonephritis or ESRD.
Signs and symptoms include bp >99th percentile for age and height and neurologic impairment. May present acutely with seizure or coma, or subacute with HA, vomiting, lethargy, blurry vision or change in mental status. Exam findings may also include papilledema.
MRI may show increased signal in occipital lobes of T2 weighted images, known as reversible posterior leukoencephalopathy.
Treatment is to lower BP by 20-25% for the first 8 hours and to normative levels over 24-48 hrs. IV therapy with esmolol drip, labetalol or nicardapine are the treatments of choice. Nitroprusside prudent in most hypertensive adult emergencies must be used cautiously if history of renal disease secondary to cyanide toxicity. Seizure should also be treated as you would with status epilepticus.
Belsha CW - Ann Emerg Med - 01-MAR-2008; 51(3 Suppl): S21-3
Herman, Andrea "Visaul Diagnosis: A Child Who Has a Nosebleed and High Blood Pressure." Pediatrics in Review 2001 22:104-107
Kleigman et al. Nelson Textbook of Pediatrics. 18th edition 598.3.
Category: Obstetrics & Gynecology
Keywords: Rhogam, Pregnancy (PubMed Search)
Posted: 8/22/2009 by Michael Bond, MD
(Updated: 2/15/2025)
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Rhogam Dosing:
Though most textbooks recommend Micro-Rhogram (50mcg) for woman that have miscarried and are less than 12 weeks gestation, you might find it a real challenge to get that dose from your pharmacy or blood bank.
The cost difference between microRhogram and Rhogam is minimal so most hospitals have decided to only stock full dose (300 mcg) Rhogam. The full dose can be given to woman in their 1st trimester without any deleterious effects.
Just remember if you are giving it as a result of a delivery you should order a Kleihauer-Betke test to determine if additional doses of Rhogam are needed.
Category: Toxicology
Keywords: priapism, yohimine, trazadone (PubMed Search)
Posted: 8/20/2009 by Fermin Barrueto
(Updated: 2/15/2025)
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Priapism - prolonged involuntary erection - is an adverse effect with some drugs. Here is a list of the more commonly reported:
Category: Neurology
Keywords: correction to altered level of consciousness pearl (PubMed Search)
Posted: 8/20/2009 by Aisha Liferidge, MD
(Updated: 8/22/2009)
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Category: Critical Care
Posted: 8/18/2009 by Mike Winters, MBA, MD
(Updated: 2/15/2025)
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High Frequency Oscillatory Ventilation (HFOV)
Stawicki SP, Goyal M, Sarani B. High frequency oscillatory ventilation and airway pressure release ventilation: a practical guide. Journal of Intensive Care Medicine 2009:24(4):215-229.
Category: Vascular
Posted: 8/17/2009 by Rob Rogers, MD
(Updated: 2/15/2025)
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Beware of older patients with groin pain!
Lower abdominal pain (mimicking diverticulitis) and isolated groin/hip pain are relatively common presentations of AAA and iliac artery aneurysm and rupture. As many as 15-20% of symptomatic AAAs wil present with hip and/or groin pain.
Bottom line: AAA and iliac artery aneurysm should at the very least be considered in older patients (and in patients with vascular disease) who present with unexplained groin/hip pain.
Category: Cardiology
Keywords: aortic, regurgitation, valvular disorders (PubMed Search)
Posted: 8/15/2009 by Amal Mattu, MD
(Updated: 2/15/2025)
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Acute aortic regurgitation pearls:
1. Most common cause is infective endocarditis
2. Also consider thoracic aortic dissection (chest pain plus new diastolic murmur)
3. Is the most common post-traumatic valvulopathy (chest trauma plus new diastolic murmur)
4. Presentation: diastolic decrescendo murmur at upper sternal border, may radiate to neck, hypotension, pulmonary edema
5. Treatment: get them to the OR! in the meantime, use vasopressors to support BP and afterload reduction to improve the pulmonary edema
Category: Endocrine
Keywords: Hypothyroidism, Elderly (PubMed Search)
Posted: 8/15/2009 by Michael Bond, MD
(Updated: 9/5/2009)
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Apathetic Hypothyroidism AKA Hypothyroidism in the Elderly
Remember that elderly do not present with classic signs and symptoms of hypothyroidism, but rather it is more common for them to have atypical presentations.
Things that make the diagnosis more difficult in the elderly are:
Consider the diagnosis in elderly patients with:
Thyroid disorders in elderly patients.
Rehman SU, Cope DW, Senseney AD, Brzezi
South Med J. 2005 May;98(5):543-9. Review.
Category: Pediatrics
Keywords: ACS, Sickle Cell (PubMed Search)
Posted: 8/14/2009 by Adam Friedlander, MD
(Updated: 2/15/2025)
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PEARL: Any patient that in your Emergency Department with a sickle cell disease (SCD)-related diagnosis requires incentive spirometry and frequent monitoring for acute chest syndrome (ACS). BRIEF WHY: ACS is the most common cause of hospitalization and death in patients with SCD.1,2 Nearly half of all patients who develop ACS are admitted for diagnoses other than ACS. Of those not admitted with ACS, radiographic and clinical findings of ACS appeared a mean of 2.5 days after admission.2 It is because of this that all patients with SCD related diagnoses at presentation, must be treated as though they are in the prodrome stage of ACS, and all require incentive spirometry to reduce the risk of progression to ACS.2 More to come...
Category: Toxicology
Keywords: treprostinil, epoprostenol, pulmonary hypertension (PubMed Search)
Posted: 8/12/2009 by Bryan Hayes, PharmD
(Updated: 2/15/2025)
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One of the treatment options for NYHA class III and IV pulmonary hypertension is prostanoids. All of the prostanoid formulations have the limitations of a short half-life and a heterogeneous response to therapy. Because the drugs need to be given by continuous infusion, patients may present to the ED due to pump failure. Sudden cardiopulmonary collapse can occur with infusion interruption. Here are some important points to remember regarding kinetics:
Category: Neurology
Keywords: dysarthria, stroke (PubMed Search)
Posted: 8/12/2009 by Aisha Liferidge, MD
(Updated: 2/15/2025)
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Depending on the location of infarct, stroke patients with dysarthria (a motor speech disorder) may exhibit the following signs and symptoms:
Category: Critical Care
Posted: 8/11/2009 by Mike Winters, MBA, MD
(Updated: 2/15/2025)
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Airway Pressure Release Ventilation (APRV)
Stawicki SP, Goyal M, Sarani B. High-frequency oscillatory ventilation and airway pressure release ventilation: A practical guide. Journal of Intensive Care Medicine 2009;24(4):215-29.
Category: Pediatrics
Keywords: Pertussis, Whooping Cough (PubMed Search)
Posted: 8/9/2009 by Heidi-Marie Kellock, MD
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Pertussis (Whooping Cough):
Nelson's Essentials of Pediatrics, 5th Edition