Category: Cardiology
Keywords: electrocardiography, ECG, STEMI, acute myocardial infarction, rescue PCI (PubMed Search)
Posted: 5/18/2008 by Amal Mattu, MD
(Updated: 10/6/2024)
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According to the most recent (2007 Updated) ACC/AHA Guidelines for management of STEMI, the ECG is one of the most important tools to assess for successful reperfusion after thrombolytics. The treating physician should assess the ECG at 90 minutes after administration of lytics. Failure of the ST elevation to decrease by at least 50% in magnitude in the lead with the greatest initial amount of ST elevation is an indication of failed thrombolysis...regardless of whether or not the patient has persistent symptoms. In fact, the Guidelines specifically state that signs and symptoms are considered unreliable indicators of successful reperfusion.
Patients with ECG evidence of failed thrombolysis at 90 minutes should be referred for emergent PCI ("rescue PCI").
Category: Pediatrics
Keywords: Retropharyngeal Abscess, Neck Pain, Torticollis, Fever (PubMed Search)
Posted: 5/16/2008 by Sean Fox, MD
(Updated: 10/6/2024)
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Retropharyngeal Abscess
Craig, FW and Schunk, JE. Retropharyngeal Abscess in Children: Clinical Presentation, Utility of Imaging, and Current Management. Pediatrics. 2003;111;1394-1398
Category: Toxicology
Keywords: cyanide (PubMed Search)
Posted: 5/15/2008 by Fermin Barrueto
(Updated: 10/6/2024)
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Toxicology Trivia for $1000 - These are in fruits of the "rose" family and in some roots that contain cyanogenic glycosides and other cyanide containing compounds. It would actually take a fair amount of work to ingest enough to reach toxicity:
Category: Neurology
Keywords: orbital floor fracture, neuropathy (PubMed Search)
Posted: 5/14/2008 by Aisha Liferidge, MD
(Updated: 10/6/2024)
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-- Enophthalmos (eye receded into the orbit) may occur when globe is
displaced posteriorly, often with prolapse of tissue into maxillary sinus.
-- Orbital dystopia (affected eye in a lower horizontal plane than the other) may
occur due to the pulling of entrapped muscle and orbital fat.
Category: Critical Care
Keywords: PEEP, acute lung injury, acute respiratory distress syndrome (PubMed Search)
Posted: 5/13/2008 by Mike Winters, MBA, MD
(Updated: 10/6/2024)
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Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)
Category: Vascular
Keywords: AV Fistula (PubMed Search)
Posted: 5/13/2008 by Rob Rogers, MD
(Updated: 10/6/2024)
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Management of Ruptured AV Fistula
This pearl pertains to a case I had 2 weeks ago. A 65 yo male presented with a massively swollen left forearm in the region of his AV fistula. On ultrasound he had a 6 X 6 cm aneurysm. He was seen by vascular and transplant surgery and taken to the OR for repair.
So, the question came up, what would an emergency physician do if this bad boy actually ruptured? Well, obviously we would hold pressure. But what if that didn't work? Well, shouldn't the patient go to the OR? The answer is a resounding yes, but what if there is no surgeon around. There is not much literature on how to handle this devastating vascular catastrophe.
As a rule of thumb, if an AV Fistula ruptures (not leaks) and the patient is exsanguinating in front of you:
J Vasc Surg 2005
Category: Cardiology
Keywords: Brugada syndrome, atrial fibrillation (PubMed Search)
Posted: 5/11/2008 by Amal Mattu, MD
(Updated: 10/6/2024)
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Brugada syndrome, believed to be responsible for up to 4-5% of all episodes of cardiac arrest, has now been associated with atrial fibrillation as well (atrial fibrillation is the most common atrial dysrhythmia associated with Brugada syndrome). Patients with atrial fibrillation that have a full or incomplete right bundle branch block with ST segment elevation in leads V1-V2 should be referred to an electrophysiologist for evaluation of Brugada syndrome. The best treatment for these patients is still placement of an ICD.
Category: Orthopedics
Keywords: Posterior Interosseous Nerve, Compression, Radial Tunnel (PubMed Search)
Posted: 5/11/2008 by Michael Bond, MD
(Updated: 10/6/2024)
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Posterior Interosseous Nerve Compression Syndrome
As eluded to last week Posterior Interosseous Nerve (PIN) Compression Syndrome, a deep branch of the radial nerve, is felt to be radial tunnel syndrome with paralysis.
Category: Pediatrics
Keywords: Acute Otitis Media, Topical Lidocaine, Wait and See, Analagesia (PubMed Search)
Posted: 5/9/2008 by Sean Fox, MD
(Updated: 10/6/2024)
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Topical Lidocaine for Acute Otitis Media
Spiro, D. Tay, K. Wait-to-see prescription for the treatment of acute otitis media. JAMA 2006, 1235.
Bolt, P., Barnett, P., Babl, F., Sharwood, L. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008; 93: 40-44.
Category: Toxicology
Posted: 5/8/2008 by Fermin Barrueto
(Updated: 10/6/2024)
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Bass. Sudden Sniffing Death. JAMA 1970.
Category: Neurology
Keywords: TIA, Stroke (PubMed Search)
Posted: 5/8/2008 by Aisha Liferidge, MD
(Updated: 10/6/2024)
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Category: Critical Care
Keywords: propofol (PubMed Search)
Posted: 5/7/2008 by Mike Winters, MBA, MD
(Updated: 10/6/2024)
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Propofol Infusion Syndrome
Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia 2007;62:690-701.
Category: Vascular
Keywords: Hypertension (PubMed Search)
Posted: 5/6/2008 by Rob Rogers, MD
(Updated: 10/6/2024)
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Side Effects of Hydrochlorothiazide
Consider the following when prescribing HCTZ from the emergency department:
The side effects of hydrochlorothiazide include hypokalemia,hypercalcemia, hypomagnesemia, metabolic alkalosis, hyponatremia, hyperuricemia (may worsen gout), hyperglycemia, hypercholesterolemia, hypertriglyceridemia.
Journal of Hypertension, 2006
Category: Cardiology
Keywords: syncope, arrhythmia (PubMed Search)
Posted: 5/4/2008 by Amal Mattu, MD
(Updated: 10/6/2024)
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Category: Orthopedics
Keywords: Radial Tunnel Syndrome (PubMed Search)
Posted: 5/3/2008 by Michael Bond, MD
(Updated: 10/6/2024)
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For those at the University of Maryland that got the chance to hear my lecture this week, you learned about Cubital tunnel syndrome [ulnar neuropathy], the second most common compressive neuropathy. Carpal Tunnel syndrome remains the number one compressive neuropathy, and this pearl, for the sake of completeness, will address Radial tunnel syndrome.
Stay tuned for next week for Posterior Interosseous Nerve syndrome.
Category: Pediatrics
Keywords: Burns, Parkland, Burn Percent, Burn Classification (PubMed Search)
Posted: 5/1/2008 by Sean Fox, MD
(Updated: 10/6/2024)
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Pediatric Burns
Duffy BJ, McLaughlin PM, Eichelberger MR. Assessment, Triage, and Early Management of Burns in Children. Clinical Pediatric Emergency Medicine. 2006; 7:82-93.
Burn Service Manual, Children’s National Medical Center. Emergency, Trauma and Burn Services, Children’s National Medical Center, Washington, DC.
Category: Toxicology
Keywords: prolonged QT, arrhythmia, adverse effect, antiarrhythmics, antibiotics, antipsychotics (PubMed Search)
Posted: 5/1/2008 by Ellen Lemkin, MD, PharmD
(Updated: 10/6/2024)
Click here to contact Ellen Lemkin, MD, PharmD
Other factors that are associated with prolonged QT include: bradycardia, female sex, genetics, and electrolyte abnormalities.
Kannakeril PJ, Roden DM. Drug-Induced long QT and torsade de pointes: recent advances. Current opinions in cardiology. Jan 2007;22(1):39-43.
Horn JR, Hansten PD. Drug Interactions and QT Interval Prolongation. Pharmacy Times Dec 2004. pp66.
Category: Neurology
Keywords: antihypertensives, blood pressure, intracranial hemorrhage (PubMed Search)
Posted: 4/30/2008 by Aisha Liferidge, MD
(Updated: 10/6/2024)
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Category: Critical Care
Keywords: intra-aortic balloon pump counterpulsation, cardiogenic shock (PubMed Search)
Posted: 4/29/2008 by Mike Winters, MBA, MD
(Updated: 10/6/2024)
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Intra-aortic balloon pump counterpulsation
Kim JT, Lee JR, Kim JK, et al. The carina as a useful radiographic landmark for positioning the intra-aortic balloon pump. Anesth & Analg 2007;105:735-8.
Category: Misc
Keywords: Leukemia (PubMed Search)
Posted: 4/28/2008 by Rob Rogers, MD
(Updated: 10/6/2024)
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Suspected Acute Leukemia in the ED
Key ED Interventions for patients with astronomically high WBC counts: