Category: Toxicology
Keywords: thyroid, hypothyroid, hyperthyroid (PubMed Search)
Posted: 12/14/2007 by Fermin Barrueto
(Updated: 2/17/2025)
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Lithium: Hypothyroidism (5-15% of pts) and goiter (37% of pts), mechanism unclear
Amiodarone (37% Iodine by weight): Hyper or Hypothroidism
Beta-Blockers: by blocking peripheral conversion of T4 to T3 cause hypothyroidism
Corticosteroid: same as beta-blockers but can also cause transient thyrotoxicosis (Jod-Basedow effect)
Iodine, Iodinated contrast, radiactive iodine all can cause hypothyroidism but iodinated contrast material can actually induce thyrotoxicosis and thyroid storm from unknown mechanism.
Category: Neurology
Keywords: Ischemic Stroke, Intra-arterial Thrombolysis, IA tPA, Intra-venous Thrombolysis, IV tPA (PubMed Search)
Posted: 12/13/2007 by Aisha Liferidge, MD
(Updated: 2/17/2025)
Click here to contact Aisha Liferidge, MD
-- candidates with severe neurological deficits (NIHSS score > 10)
-- candidates with a recent history of major surgical procedures
-- candidates with occlusion of major cervical or intracranial vessels
Zaidat OO, Saurez JL, Santillan C, et al. "Response to intra-arterial and combined intravenous and intra-arterial thrombolytic therapy in patients with distal internal carotid artery occlusion." Stroke 2002, 33: 1821-1826.
Bellolio MF, et al. "Stroke Update 2007: Better Early Stroke Treatment (BEST)," Emergency Medicine Practice, Augst 2007, Volume 9, Number 8.
Category: Critical Care
Keywords: pulmonary edema, aortic dissection, heroin (PubMed Search)
Posted: 12/11/2007 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
Click here to contact Mike Winters, MBA, MD
Unilateral Pulmonary Edema
Category: Vascular
Keywords: subarachnoid hemorrhage (PubMed Search)
Posted: 12/10/2007 by Rob Rogers, MD
(Updated: 2/17/2025)
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Subarachnoid hemorrhage: Unilateral or bilateral headache?
Pretty good evidence exists that most patients with subarachnoid hemorrhage will have a bilateral headache.
In fact, unilateral headache is helpful in the history in ruling out SAH in most cases. Presence of an unruptured aneurysm, however can be present with a unilateral headache.
J NeuroSurg 2006
Category: Cardiology
Keywords: Acute coronary syndromes, women (PubMed Search)
Posted: 12/9/2007 by Amal Mattu, MD
(Updated: 2/17/2025)
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Category: Med-Legal
Posted: 12/1/2007 by Michael Bond, MD
(Updated: 2/17/2025)
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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: 2/17/2025)
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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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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: 2/17/2025)
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
(Updated: 2/17/2025)
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
(Updated: 2/17/2025)
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: