Category: Pediatrics
Keywords: Erythema Infectiosum,parvovirus B-19 (PubMed Search)
Posted: 10/24/2008 by Don Van Wie, DO
(Updated: 11/10/2024)
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With the cooler weather on us all our favorite viral infections will start to appear. Included in this is the "slapped - cheek disease" Erythema infectiosum.
Erythema Infectiosum
Category: Toxicology
Keywords: anticholinergic, olanzapineA (PubMed Search)
Posted: 10/24/2008 by Fermin Barrueto
(Updated: 11/10/2024)
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Olanzapine (Zyprexa)
This is an atypical antipsychotic that gained popularity because it caused less sedation and fewer extrapyramidal effects. However, there are many other adverse effects that need to be emphasized. Some of these may contribute to a patient's condition in the ED:
Category: Neurology
Keywords: migraine, anitemetic, Reglan, metoclopramide, prochlorperazine, Compazine, diphenhydramine (PubMed Search)
Posted: 10/22/2008 by Aisha Liferidge, MD
(Updated: 11/10/2024)
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Category: Critical Care
Keywords: influenza, zanamivir, oseltamivir (PubMed Search)
Posted: 10/21/2008 by Mike Winters, MBA, MD
(Updated: 11/10/2024)
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Influenza and the Critically Ill
Beigel JH. Influenza. Crit Care Med 2008;36:2660-6.
Category: Vascular
Keywords: HeparinPro (PubMed Search)
Posted: 10/20/2008 by Rob Rogers, MD
(Updated: 11/10/2024)
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Anticoagulation with Heparin-How to Reverse?
So you just started Heparin on that ACS patient? Just bolused the patient in room 12 with the large PE with a slug of Heparin? The nurse tells you that one of them just vomited blood and the other just had a large bloody bowel movement. What to do, oh, what to do?
How to reverse Heparin...use Protamine:
Category: Cardiology
Posted: 10/19/2008 by Amal Mattu, MD
(Updated: 11/10/2024)
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Amiodarone-induced hypothyroidism is well-reported and should be considered anytime a patient that chronically takes amiodarone presents with hypothyroid symptoms, including decompensated CHF, decreased mental status, or myxedema coma (e.g. bradycardia, hypotension, hypothermia).
Other drugs that have been implicated in producing hypothyroidism include lithium, iodine, iodinated contrast, and sulfonamides.
Category: Toxicology
Keywords: bisphenol A, diabetes (PubMed Search)
Posted: 10/16/2008 by Fermin Barrueto
(Updated: 11/10/2024)
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Bisphenol A (BPA) is found in epoxy resins that line common food and beverage materials. There has been concern that this compound, like phthalates, may be causing harm through chronic low exposure. An epidemiologic study was performed and published in JAMA that has raised this question. Amazingly, the study did find that:
Lange et al. JAMA 2008; 300(11): 1303-1310.
Category: Neurology
Keywords: Tourette Syndrome, vocal tics, motor tics (PubMed Search)
Posted: 10/15/2008 by Aisha Liferidge, MD
(Updated: 11/10/2024)
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-- Tourette Syndrome (TS) is an inherited neurological disorder characterized by repetitive involuntary movements and uncontrollable vocal sounds called tics.
-- Underlying defect is unknown; however, research suggests that it could be caused by abnormalities in serotonin and dopamine activity within the basal ganglia.
-- Associated behavioral problems include OCD, ADHD, anxiety, and depression.
Diagnostic criteria:
Category: Infectious Disease
Keywords: spontaneous bacterial peritonitis, ascites, paracentesis (PubMed Search)
Posted: 10/14/2008 by Mike Winters, MBA, MD
(Updated: 11/10/2024)
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Can You Rely on Your Clinical Impression to Exclude SBP?
Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW. Ann Emerg Med 2008;52:268-73.
Category: Vascular
Keywords: Thrombosis, Cerebral (PubMed Search)
Posted: 10/13/2008 by Rob Rogers, MD
(Updated: 11/10/2024)
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Cerebral Venous Sinus Thrombosis (CVST)
An uncommon but very serious entity that leads to three distinct types of presentations:
Caused by thrombosis of one of the intracerebral venous sinuses (most commonly the transverse sinus) The major risk factor is hypercoagulable disease. May be the underlying cause of a majority of cases of idiopathic intracranial hypertension.
When to suspect:
Diagnosis:
Treat:
Category: Cardiology
Keywords: coronary spasm,acute coronary syndrome (PubMed Search)
Posted: 10/12/2008 by Amal Mattu, MD
(Updated: 11/10/2024)
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An estimated 20-30% of patients with ACS end up having no identifiable culprit lesion on angiography. Almost half of these patients have inducible coronary spasm. Although these patients have a good outcome, they also have a tendency to return to the hospital for frequent re-evaluations. Evaluation for and treatment of spasm can improve the quality of life for these patients and also to decrease re-visits.
When patients with reports of "clean" coronaries return to the ED with a concerning presentation for ACS, one of the considerations should be coronary spasm. Consider prompting the primary care physician or admitting team to look into this possibility, as it may result in a reduction in recurrent ED visits.
Category: Misc
Keywords: Hypothyroidism, Myxedema, Treatment (PubMed Search)
Posted: 10/11/2008 by Michael Bond, MD
(Updated: 11/10/2024)
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Severe Hypothyroidism or Myxedema Coma
Category: Pediatrics
Keywords: Pediatric Discitis, epidural absces (PubMed Search)
Posted: 10/10/2008 by Don Van Wie, DO
(Updated: 11/10/2024)
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Pediatric Discitis is an intervertebral disc infection due to hematogenous spread to vascular channels in cartilage that disappear later in life. In 1/3 of patients it is caused by S. aureus.
Presenting Features
Management is to exclude more severe disease (osteomylelitis,abscess, tumor) and antibiotic use is debatable. Remember children this age rarely complain of back pain.
Pediatrics 2000; 105: 1299
Category: Toxicology
Keywords: lead (PubMed Search)
Posted: 10/10/2008 by Fermin Barrueto
(Updated: 11/10/2024)
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Clinical Manifestations in relation to lead level in children:
Category: Critical Care
Keywords: gastrothorax, pneumothorax (PubMed Search)
Posted: 10/8/2008 by Mike Winters, MBA, MD
(Updated: 11/10/2024)
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Tension gastrothorax?
Patton J, Gonzales J, Dillard TA, Szerlip HM. Chest 2008;134:872-5.
Category: Vascular
Keywords: Hypertension, Headache (PubMed Search)
Posted: 10/6/2008 by Rob Rogers, MD
(Updated: 11/10/2024)
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Does Hypertension (elevated BP) Cause Headache?
This is an age old question that many of us have struggled with in the ED for many years...
Other questions include: Does elevated BP cause headaches? Do we need to scan hypertensive patients with headache just because they have a headache? At what level of BP does the BP actually cause headache?
A few quick pearls:
Category: Cardiology
Keywords: cardiomyopathy, stress (PubMed Search)
Posted: 10/5/2008 by Amal Mattu, MD
(Updated: 11/10/2024)
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Severe emotional stress is well-reported to produce an unusual transient cardiomyopathy that mimics cardiac ischemia or infarction on ECG as well as biomarker testing. On angiography, the coronaries are often clean. The ventriculogram takes on an apical or mid-ventricular ballooning appearance due to akinesis. In the ED, these patients will look just like a real thrombosis-related case of ACS and they often develop cardiogenic shock. Unlike true AMI-related cardiogenic shock, these patients have an excellent prognosis...if treated aggressively early-on with supportive therapy (e.g. pressors).
Intracranial catastrophes, such as hemorrhage, ischemic stroke, and head trauma; and severe medical illnesses, such as sepsis, pheochromocytoma, and catecholamine-excess states, are also reported to produce a similar syndrome of LV dysfunction.
The takeaway points: (1) severe emotional stress can be deadly...be wary of diagnosing "anxiety" or "panic attack" without checking an ECG; (2) check an ECG early in the course of any patients with the above conditions that look sick; (3) if the ECG shows signs of severe ischemia, aggressive treatment can be life-saving.
[ref: Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation 2008;118;397-409.]
Category: Orthopedics
Keywords: Mallet Finger, Extensor Tendon Injury (PubMed Search)
Posted: 10/5/2008 by Michael Bond, MD
(Updated: 11/10/2024)
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Mallet Finger:
A common injury resulting in a tear or avulsion of the extensor digitorium tendon inserting into the base of the distal phalanx. Occurs due to hyperflexion of the finger usually as of a esult of it getting jammed on a ball while playing sports. Most can be treated non-surgically.
The distal phalanx must be kept in full extension for 6 to 8 weeks. This is one of the few times that the finger should not be splinted in the position of function.
Make sure that patient is informed that if they remove the splint and flex their finger the 6 to 8 week healing window will be reset to day 0. These patients should not be doing ROM exercises and must wear the splint full time.
Category: Pediatrics
Keywords: popsicle panniculitis, cold panniculitis, child abuse (PubMed Search)
Posted: 10/3/2008 by Don Van Wie, DO
(Updated: 11/10/2024)
Click here to contact Don Van Wie, DO
Popsicle or cold panniculitis is an inflammation of the subcutaneous fat after prolonged exposure to cold. It is thought to occur more often in infants and young children because they have a higher percentage of saturated fatty acids than older children and adults. Pediatric patients may present to you to be evaluated/ruled out for abuse by social workers, schools, or police and if you have the correct history it is easy to dispo quickly.
Clinical Features of Popsicle Panniculitis
Shah B. Lucchesi M. Atlas of Pediatric Emergency Medicine. McGraw-Hill Companies. 2006.
Category: Toxicology
Keywords: ICP, intracranial pressure, antihypertensive, nitroprusside, nitroglycerin, hydralazine (PubMed Search)
Posted: 10/2/2008 by Ellen Lemkin, MD, PharmD
(Updated: 11/10/2024)
Click here to contact Ellen Lemkin, MD, PharmD
Several antihypertensive agents raise intracranial pressure. Normal cerebral blood flow (CBF) is constant within normal cerebral perfusion pressure (CPP) ranges, recalling that CPP=MAP-ICP.
If CPP is outside the range in which autoregulation occurs, e.g. due to a structural lesion, ischemic stroke, or head trauma, CBF decreases and can adversely affect the patient.
In patients with ischemic stroke or intracerebral pathology, labetalol or esmolol may be used to lower blood pressure without raising ICP. Nicardipine is recommended for use in patients with ischemic stroke or SAH but not in patients with brain injury
If the patient has NO structural abnormalities, but has hypertensive encephalopathy, nitroglycerin, nitroprusside, labetalol, esmolol, or nicardipine may be used.