Category: Med-Legal
Posted: 12/1/2007 by Michael Bond, MD
(Emailed: 12/8/2007)
(Updated: 11/3/2024)
Click here to contact Michael Bond, MD
EMTALA (Part Two)
Thanks to Larry Weiss, MD, JD
Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice.The speaker provides this information only for Continuing Medical Education purposes.
Category: Pediatrics
Keywords: Neonatal Respiratory Distress Syndrome, RDS, Cold Stress, Surfactant (PubMed Search)
Posted: 12/7/2007 by Sean Fox, MD
(Updated: 11/3/2024)
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The Premature Infant Delivered in Your Department
An ode to my final NICU Call… just because you don’t work in a Pediatric ED, doesn’t mean you won’t encounter premature infants.
What do you need to remember when a premature infant is born in your ED (or the ambulance / cab / car)?
Category: Toxicology
Keywords: ondansetron,metoclopramide (PubMed Search)
Posted: 12/7/2007 by Fermin Barrueto
(Updated: 11/3/2024)
Click here to contact Fermin Barrueto
Everything you need to know about anti-emetics, mechanism of action, potency and toxicity:
1) 5-HT3 Blockers - Ondansetron, Granistron
- The most potent anti-emetic, only toxicity is really cost
2) Dopamine Blockers - Metoclopramide
- Can titrate to high doses, causes dystonia, akathisia and mild QT prolongation
3) Anticholinergic - Promethazine, meclizine, diphenhydramine
- Cannot titrate, most sedating, urinary retention in elderly, mild QT prolongation
Category: Neurology
Keywords: aspirin, stroke (PubMed Search)
Posted: 12/5/2007 by Aisha Liferidge, MD
(Updated: 11/3/2024)
Click here to contact Aisha Liferidge, MD
2007 AHA and ASA Guidelines for the Early Management of Adults with Ischemic Stroke and Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults.
Category: Vascular
Keywords: ECG, Aortic Dissection (PubMed Search)
Posted: 12/4/2007 by Rob Rogers, MD
(Updated: 11/3/2024)
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ECG gating CTs for aortic dissection/aneurysm rule out
AJR 2007
Category: Critical Care
Keywords: massive hemoptysis (PubMed Search)
Posted: 12/4/2007 by Mike Winters, MBA, MD
(Updated: 11/3/2024)
Click here to contact Mike Winters, MBA, MD
Massive hemoptysis
Category: Cardiology
Keywords: endocarditis, mitral valve prolapse (PubMed Search)
Posted: 12/2/2007 by Amal Mattu, MD
(Updated: 11/3/2024)
Click here to contact Amal Mattu, MD
Rheumatic heart disease (RHD) has traditionally been considered the most common underlying condition predisoposing to infective endocarditis. While RHD is still common in developing countries, its prevalence has declined and "mitral valve prolapse is now the most common underlying condition in patients with infective endocarditis."
(from AHA Guideline on Prevention of Infective Endocarditis, Circulation, October 9, 2007)
Category: Med-Legal
Keywords: EMTALA, medicolegal (PubMed Search)
Posted: 12/1/2007 by Michael Bond, MD
(Updated: 11/3/2024)
Click here to contact Michael Bond, MD
EMTALA (Part One):
Thanks to Larry Weiss, MD, JD
Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice.The speaker provides this information only for Continuing Medical Education purposes.
Category: Pediatrics
Keywords: Pediatric Airway, Pierre Robin Syndrome, Micrognathia, Emergent Tracheostomy, LMA (PubMed Search)
Posted: 11/30/2007 by Sean Fox, MD
(Updated: 11/3/2024)
Click here to contact Sean Fox, MD
Pierre Robin Syndrome
Baraka, A. Laryngeal Mask Airway for Resuscitation of a Newborn with Pierre-Robin Syndrome. Anesthesiology. 83(3):646-647, September 1995.
Category: Toxicology
Keywords: radiocontrast, nephropathy, renal failure (PubMed Search)
Posted: 11/29/2007 by Fermin Barrueto
(Updated: 11/3/2024)
Click here to contact Fermin Barrueto
Category: Neurology
Keywords: pituitary apoplexy, subarachnoid hemorrhage, SAH, headache, ophthalmoplegia (PubMed Search)
Posted: 11/28/2007 by Aisha Liferidge, MD
(Updated: 11/3/2024)
Click here to contact Aisha Liferidge, MD
Today's joint conference with the UMMS' Neurology Department was quite beneficial and applicable to our daily practice in the Emergency Department (ED).
The topics discussed included:
While the information provided for each of these clinical topics was comprehensive, be sure to review these disorders in the near future, in order to commit them to memory and increase your comfort level with diagnosing and treating them in the ED. If you'd like a copy of the handouts, just let me know.
Today's pearl will highlight pituitary apoplexy.
Take Home Points about Pituitary Apoplexy:
Category: Critical Care
Posted: 11/27/2007 by Mike Winters, MBA, MD
(Updated: 11/3/2024)
Click here to contact Mike Winters, MBA, MD
Acute Liver Failure
Stravitz RT, et al. Intensive care of patients with acute liver failure. Crit Care Med 2007;35:2498-2508.
Category: Vascular
Keywords: Aortic Dissection (PubMed Search)
Posted: 11/26/2007 by Rob Rogers, MD
(Updated: 11/3/2024)
Click here to contact Rob Rogers, MD
A few pearls regarding Acute Aortic Dissection...
Elefteriades. Acute Aortic Disorders. 2007
Category: Med-Legal
Keywords: abdominal pain, exam, legal, pitfall, missed (PubMed Search)
Posted: 11/23/2007 by Dan Lemkin, MS, MD
(Emailed: 11/26/2007)
(Updated: 11/3/2024)
Click here to contact Dan Lemkin, MS, MD
Abdominal pain can be very confusing. Occasionally, serious etiologies may masquarade as benign complaints. Always consider the following pitfalls when addressing abdominal complaints.
Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice. The speaker provides this information only for Continuing Medical Education purposes.
Content abstracted from: Nguyen Anh, Nguyen Dung. Learning from Medical Errors. Radcliffe Publishing, UK. 2005. P 11-13.
Category: Cardiology
Keywords: adenosine, supraventricular tachycardia, SVT (PubMed Search)
Posted: 11/22/2007 by Amal Mattu, MD
(Emailed: 11/26/2007)
(Updated: 11/3/2024)
Click here to contact Amal Mattu, MD
The standard dose for adenosine in treating SVT is 6 mg given as a rapid IV push. The dose should be immediately followed by a saline flush and works best if the drug is administered through a good, proximal (e.g. antecubital) IV line.
A few points:
Category: Pediatrics
Keywords: Proteinuria, Orthostatic Proteinuria, Creatinine (PubMed Search)
Posted: 11/23/2007 by Sean Fox, MD
(Updated: 11/3/2024)
Click here to contact Sean Fox, MD
Proteinuria
Chandar J, Gomez-Martin O, del Pozo R, et al. Role of routine urinalysis in asymptomatic pediatric patients. Clin Pediatr (Phila). 2005; 44:44-48.
Hogg RJ, Portman Rj, Milliner D, Lemley KV, Eddy A, Ingelfinger J. Evaluation and management of proteinuria and nephritic syndrome in children recommendations from a pediatric nephrology panel established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE). Pediatrics. 2000; 105: 1242-1249.
Category: Toxicology
Keywords: Food Poisoning, tetrodotoxin, ciguatera toxin (PubMed Search)
Posted: 11/22/2007 by Fermin Barrueto
(Updated: 11/3/2024)
Click here to contact Fermin Barrueto
A short list of some of the unique food poisonings and the toxicologic effects:
Category: Critical Care
Keywords: esophageal varices, upper gastrointestinal bleeding, antibiotics (PubMed Search)
Posted: 11/20/2007 by Mike Winters, MBA, MD
(Updated: 11/3/2024)
Click here to contact Mike Winters, MBA, MD
A few days ago Dr. Jump and I had a case of an acute variceal hemorrhage. Dr. Bond already sent out a great pearl earlier in the year highlighting the importance of octreotide in acute variceal bleeding. In fact, octreotide alone can result in cessation of hemorrhage in up to 80% of patients. To add onto Dr. Bond's pearl:
Category: Vascular
Keywords: Aortic Dissection (PubMed Search)
Posted: 11/19/2007 by Rob Rogers, MD
(Updated: 11/3/2024)
Click here to contact Rob Rogers, MD
Patients with aortic dissection (Type A or B) who develop intestinal/renal, etc. ischemia should be considered for aortic fenestration-a procedure in which holes are literally created in the aortic lumen to connect the true and false lumen-this allows perfusion of the involved vessel to occur from true lumen into the false lumen into the involved vessel.
Patients with large vessel malperfusion have a VERY HIGH mortality rate, AND most CT surgeons will not operate even on a Type A unless the involved vessels have been opened up.
This procedure is useful when major vessels (SMA as an example) branch from the aortic false lumen.
So, when to consider this procedure:
Who do you call?
Category: Cardiology
Keywords: bradycardia, pacemaker (PubMed Search)
Posted: 11/18/2007 by Amal Mattu, MD
(Updated: 11/3/2024)
Click here to contact Amal Mattu, MD
A few pearls regarding pacing a patient with an unstable bradycardia:
If the patient has an implanted pacemaker (which isn't working properly), the transcutaneous pacing pads should be placed at least 10 cm away from the implanted PM pulse generator.
Placement of a transvenous pacemaker is absolutely contraindicated if the patient has a prosthetic tricuspid valve.
Neither transcutaneous or transvenos pacing is likely to work in the setting of severe acidosis or severe hypothermia. Severely hypothermic patients, in fact, have very irritible myocardial tissue and therefore attempts at pacing may produce ventricular dysrhythmias.