Category: Critical Care
Posted: 3/17/2009 by Mike Winters, MBA, MD
(Updated: 11/26/2024)
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Early Critical Care Management of Aneurysmal SAH
Diringer MN. Managment of aneurysmal subarachnoid hemorrhage. Crit Care Med 2009;37:432-40.
Category: Airway Management
Keywords: Airway (PubMed Search)
Posted: 3/16/2009 by Rob Rogers, MD
(Updated: 11/26/2024)
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Keys to a Successful Intubation
The famous Ken Butler
Category: Orthopedics
Keywords: Child Abuse, Fracture (PubMed Search)
Posted: 3/15/2009 by Michael Bond, MD
(Updated: 11/26/2024)
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A lot of what is taught about fracture patterns in abused children has been extrapolated from post-mortem studies which is a different population then what you will see in the Emergency Department. The study referenced did a metanalysis of all the literature in an attempt to determine what fractures suggest abuse and looked at all comers that had fractures. Some of the patterns they were able to extrapolate are:
Patterns of Skeletal Fractures in Child Abuse: Systemic Review. BMJ, Alison M Kemp et al. 2008;337:a1518
Category: Pediatrics
Keywords: Appendicitis, Pediatrics (PubMed Search)
Posted: 3/13/2009 by Don Van Wie, DO
(Updated: 11/26/2024)
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Acute Appendicitis in Childhood: Diagnosis and Treatment in the new Millennium. PEM Practice. December 2008
Category: Toxicology
Keywords: metoclopramide, black box warning, tardive dyskinesia (PubMed Search)
Posted: 3/12/2009 by Bryan Hayes, PharmD
(Updated: 11/26/2024)
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Add metoclopramide (Reglan) to the laundry list of medications with black box warnings from the FDA. Why was a black box warning added?
Category: Neurology
Keywords: nihss, stroke scale (PubMed Search)
Posted: 3/11/2009 by Aisha Liferidge, MD
(Updated: 11/26/2024)
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Category: Vascular
Keywords: Hypertensive (PubMed Search)
Posted: 3/10/2009 by Rob Rogers, MD
(Updated: 11/26/2024)
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Follow-up for the Hypertensive Patient
We see hypertensive patients every day, every shift. And, we discharge many of them. So, when do you get them follow-up?
The JNC-7 recommends that patients with BPs > 180/110 mm Hg have follow-up within 7 days. Like most of the HTN recommendations in the primary care setting, this recommendation is based on a "smart person" concensus....and no data.
This is a tremendous issue for us in the ED, because we don't want to see a bad outcome in our discharged hypertensive patients.
Some pearls regarding discharging the very hypertensive (but asymtomatic) patient:
Category: Cardiology
Keywords: tamponade, pericardial tamponade, intubation, positive pressure ventilation, complications (PubMed Search)
Posted: 3/8/2009 by Amal Mattu, MD
(Updated: 11/26/2024)
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Category: Orthopedics
Keywords: Galeazzi, Fracture (PubMed Search)
Posted: 3/7/2009 by Michael Bond, MD
(Updated: 11/26/2024)
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The Galeazzi Fracture:
To see a photo of a Galeazzi fracture please visit the Learning Radiology Website by clicking on the following link:
http://www.learningradiology.com/caseofweek/caseoftheweekpix2/cow157lg.jpg
Category: Pediatrics
Posted: 3/6/2009 by Rose Chasm, MD
(Updated: 11/26/2024)
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Rocky Mountain spotted fever (RMSF)
Systemic small vessel vasculitis caused by R rickettsii which is transmitted by a tick bite.
Clinical features: fever, headache, myalgia, nausea, vomiting, and characteristic rash. Rash usually appears before the sixth day of the illness initially on the wrists and ankles, and spreads to the trunk within hours. Initially. It is erythematous and macular, later becoming petechial.
Laboratory findings: thrombocytopenia, anemia, and hyponatremia.
Complications: meningitis, multiorgan involvement, DIC, shock, and death.
Treatment: doxcycycline (even despite the risk of dental staining in children younger than 8 years old)
American Academy of Pediatrics. Rickettsial diseases, Rickettsialpox, Rocky Mountain spotted fever. In: Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2006:529-534.
Category: Toxicology
Keywords: Clevidipine, calcium channel antagonist, calcium channel blocker, antihypertensive (PubMed Search)
Posted: 3/5/2009 by Ellen Lemkin, MD, PharmD
(Updated: 11/26/2024)
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Clevidipine
1. Anon. The Medical Letter. Sept 22 2008;50(1295)73-4.
Category: Neurology
Keywords: cavernous sinus thrombosis, extraocular palsies (PubMed Search)
Posted: 3/5/2009 by Aisha Liferidge, MD
(Updated: 11/26/2024)
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Category: Vascular
Keywords: Hypertension, End-Organ Damage (PubMed Search)
Posted: 3/3/2009 by Rob Rogers, MD
(Updated: 11/26/2024)
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Evaluation of End Organ Damage in Hypertensive Patients
No evidence to date supports the ED workup for end-organ damage in asymptomatic hypertensive patients.
End-Organ Damage Pearls:
Category: Critical Care
Posted: 3/3/2009 by Mike Winters, MBA, MD
(Updated: 11/26/2024)
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Neuromuscular Blocking Agent (NMBA)
Category: Cardiology
Keywords: electrocardiography, acute myocardial infarction (PubMed Search)
Posted: 3/2/2009 by Amal Mattu, MD
(Updated: 11/26/2024)
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Category: Orthopedics
Keywords: Ottawa, Ankle, Knee, Foot (PubMed Search)
Posted: 2/28/2009 by Michael Bond, MD
(Updated: 11/26/2024)
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Most people are familiar with the Ottawa Ankle Rules, but there are also Ottawa Knee and Foot rules. The Ottawa rules help to limit the number of x-rays you may need in patients that present with ankle, foot or knee pain after an injury.
The Ottawa Ankle Rule
An ankle x-ray is only needed if there pain in the mallelolar area and any of the following:
The Ottawa Foot Rule
A foot x-ray is only needed if there is pain in the midfoot and any of the following:
The Ottawa Knee Rule
A knee x-ray is only needed for knee injury patients when they have any of the following:
Category: Pediatrics
Keywords: pediatric seizures (PubMed Search)
Posted: 2/28/2009 by Don Van Wie, DO
(Updated: 11/26/2024)
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Berg C, Schumann H. An Evidence-Based Approach to Pediatric Seizures in the Emergency Department. Pediatric Emergency Medicine Practice. Feb 2009. Vol 6, Number 2.
Category: Toxicology
Keywords: ondansetron, albuterol (PubMed Search)
Posted: 2/26/2009 by Fermin Barrueto
(Updated: 11/26/2024)
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Category: Critical Care
Posted: 2/24/2009 by Mike Winters, MBA, MD
(Updated: 11/26/2024)
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The Crashing Intubated ED Patient
Category: Airway Management
Keywords: Brugada syndrome (PubMed Search)
Posted: 2/22/2009 by Amal Mattu, MD
(Updated: 11/26/2024)
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