Category: Neurology
Keywords: gcs, glasgow coma scale (PubMed Search)
Posted: 1/15/2009 by Aisha Liferidge, MD
(Updated: 11/1/2024)
Click here to contact Aisha Liferidge, MD
Category: Critical Care
Keywords: sepsis, mechanical ventilation, oxygen delivery (PubMed Search)
Posted: 1/13/2009 by Mike Winters, MBA, MD
(Updated: 11/1/2024)
Click here to contact Mike Winters, MBA, MD
Sepsis and Mechanical Ventilation
Category: Vascular
Posted: 1/12/2009 by Rob Rogers, MD
(Updated: 11/1/2024)
Click here to contact Rob Rogers, MD
Thrombolytic Therapy for Pulmonary Embolism
Indications for administration of fibrinolytic therapy for acute PE:
Kline. Carolinas Medical Center.
Stein. Pulmonary Embolism. 2008
Category: Cardiology
Keywords: cardiac arrest, ventilation, oxygenation (PubMed Search)
Posted: 1/11/2009 by Amal Mattu, MD
(Updated: 11/1/2024)
Click here to contact Amal Mattu, MD
Category: ENT
Keywords: Conjunctivitis (PubMed Search)
Posted: 1/11/2009 by Michael Bond, MD
(Updated: 11/1/2024)
Click here to contact Michael Bond, MD
Conjunctivitis:
Patient presenting to the Emergency Department complaining of "Pink Eye" is very common but how can you be sure that they do not have a bacterial conjunctivitis and absolutely need antibiotics or are they just suffering from a viral or allergic conjunctivitis.
Category: Pediatrics
Keywords: Pediatric Burns (PubMed Search)
Posted: 1/10/2009 by Don Van Wie, DO
(Updated: 11/1/2024)
Click here to contact Don Van Wie, DO
Granger,Estrada,Abramo. An Evidence-Based Approach to Pediatric Burns. Pediatric Emergency Medicine Practice. Jan 2009. Vol6,No 1
Category: Toxicology
Keywords: methadone, QT prolongation, torsade de pointes, magnesium (PubMed Search)
Posted: 1/7/2009 by Bryan Hayes, PharmD
(Emailed: 1/8/2009)
(Updated: 11/1/2024)
Click here to contact Bryan Hayes, PharmD
A few previous pearls have touched on identifying drugs that cause QT prolongation. In our patient population, methadone is one of the more common causes of drug-induced prolonged QT syndrome. Of 692 physicians surveyed (35% family practitioners, 25% internests, 22% psychiatrists, and 8% self-identified addiction specialists) only 41% were aware of methadone's QT-prolonging properties and just 24% were aware of methadone's association with torsade de pointes.
Now that you know, what do you do when a patient on methadone presents with a QTC of 580 msec and intermittent runs of vtach and torsade de pointes?
The answer is... the exact same thing you would do with any other patient who presents this way, regardless of the cause.
Buprenorphine, an alternative to methadone, is not associated with prolonged QT syndrome.
References
Category: Neurology
Keywords: glasgow coma scale, glasgow coma score, gcs, concsious, head injury (PubMed Search)
Posted: 1/7/2009 by Aisha Liferidge, MD
(Updated: 11/1/2024)
Click here to contact Aisha Liferidge, MD
Category: Critical Care
Keywords: intracerebral hemorrhage, normal saline, hypertonic saline (PubMed Search)
Posted: 1/7/2009 by Mike Winters, MBA, MD
(Updated: 11/1/2024)
Click here to contact Mike Winters, MBA, MD
Intracerebral hemorrhage and fluid management
Rincon F, Mayer SA. Clinical review: critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008;12:237.
Category: Vascular
Keywords: Acute, Aortic Dissection, Neurologic (PubMed Search)
Posted: 1/6/2009 by Rob Rogers, MD
(Updated: 11/1/2024)
Click here to contact Rob Rogers, MD
Neurologic Manifestations of Acute Aortic Dissection
A myriad of neurologic presentations of acute aortic dissection have been reported in the literature. Although classic CVA symptoms may occur, nonspecific neurologic symptoms are much more common
These include:
Take Home Point:
Elefteriades
Category: ENT
Keywords: Otitis Externa, Malginant (PubMed Search)
Posted: 1/4/2009 by Michael Bond, MD
(Updated: 11/1/2024)
Click here to contact Michael Bond, MD
Otitis Externa:
Infections of the external ear canal are common and can typically be treated with topical antibiotic solutions (Cortisporin Otic, Cipro Otic, etc...) or antibiotic solutions mixed with topical steroids (Cortisporin HC Otic, Cipro HC Otic, etc...). Most patients should not require PO or IV antibiotics.
However, you need to always be on the look out for malginant otitis externa (MOE) which is a more deep seated infeciton extending into the temporal bone and can have a mortality rate as high as 50%. Patients that are diabetic, immunospressed, or have had radiation therapy to the base of the skull are at increased risk. Patients with MOE typically have pain out of proportion to clinical findings and granulation tissue may be present in the ear canal. Suspect this diagnosis in patients that have cellulitis or extreme tenderness over the mastoid process.
If you suspect MOE the patient should be started on antibiotics that cover pseudomonas. Consider obtaining a CT scan with temporal bone cuts and an Otolaryngology consultation.
Category: Pediatrics
Keywords: pediatric procedual sedation, ketamine (PubMed Search)
Posted: 1/3/2009 by Don Van Wie, DO
(Updated: 11/1/2024)
Click here to contact Don Van Wie, DO
Next time you have to do a full septic work up on a 2 month old with a fever of 104 F consider giving Ketamine 3mg/kg IM before even starting. Then you can obtain your cath urine, IV, and LP with a calm pain free patient!!
Ketamine induces a catatonic state that provides sedation, analgesia, and amnesia. It does not affect pharyngeal-laryngeal reflexes and the patient maintains a patent airway. This makes it very useful when fasting is not assured.
Route Onset Duration Dose
IM 3-5 min 20-30min 3-5 mg/kg
IV 1 min 5-10 min 1-2 mg/kg
Category: Toxicology
Keywords: Cocaine, stroke, crack lung, headache, seizures, hyperthermia, stroke (PubMed Search)
Posted: 1/1/2009 by Ellen Lemkin, MD, PharmD
(Updated: 11/1/2024)
Click here to contact Ellen Lemkin, MD, PharmD
Although we tend to think of ACS with cocaine use, there are many other serious complications, including:
1. Glauser J, Queen JR. Non-Cardiac Cocaine Toxicity. JEM Feb 2007;32(2):181-6.
Category: Critical Care
Keywords: blood pressure, intracerebral hemorrhage (PubMed Search)
Posted: 12/31/2008 by Mike Winters, MBA, MD
(Updated: 11/1/2024)
Click here to contact Mike Winters, MBA, MD
Blood Pressure Control in ICH
Rincon F, Mayer SA. Clinical review: critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008;12:237.
Category: Infectious Disease
Keywords: Infections, Temperature (PubMed Search)
Posted: 12/29/2008 by Rob Rogers, MD
(Updated: 11/1/2024)
Click here to contact Rob Rogers, MD
This pearl is dedicated to Dr. Michael Rolnick....
Infections That Cause Temperature-PulseDissociation
Certain infections may cause temperature-pulse dissociation (relative bradycardia in association with fever).
Remember that normally there will be an increase in pulse rate by 10 bpm for every 1 degree increase in temperature. So, if a patient has a temperature of 103 F, expect them to be tachycardic.
Any intracellular organism has the potential to cause a relative bradycardia (Faget's sign)
Infections that cause dissociation:
Category: Cardiology
Keywords: heart failure, congestive heart failure, CHF, diastolic dysfunction (PubMed Search)
Posted: 12/28/2008 by Amal Mattu, MD
(Updated: 11/1/2024)
Click here to contact Amal Mattu, MD
Category: Infectious Disease
Keywords: CA-MRSA, Treatment (PubMed Search)
Posted: 12/27/2008 by Michael Bond, MD
(Updated: 11/1/2024)
Click here to contact Michael Bond, MD
It is almost impossible to get through a shift these days with out seeing an abscess that is caused by CA-MRSA. As of the 2007 Antibiotic nomogram (2008 data not yet available) at University of Maryland CA-MRSA was only 70% sensitive to clindamycin, and >98% sensitive to bactrim and > 96% sensitive to doxcycline. A local community hospital in Baltimore is showing only 55% sensitivity to clindamycin.
As a New Year's resolution to yourself I recommend that you check with your local hospital's Micrology department to see what the sensitivities are to bactrim, clindamycin, doxycycline. If sensitivities are less than 80% it would generally be recommended that these medications not be used as initial empiric treatment.
For Baltimore bactrim and doxycycline should probably be the preferred treatment options.
Have a Great New Year.
Category: Pediatrics
Keywords: Proprofol,pediatrics,pediatric procedural sedation (PubMed Search)
Posted: 12/26/2008 by Don Van Wie, DO
(Updated: 11/1/2024)
Click here to contact Don Van Wie, DO
Propofol is an IV hypnotic that is made in a soy-based emulsion containing soybean oil, egg lecithin, and glycerol. It has a very rapid onset time (10-50 seconds) and a brief duration of action making it ideal for ED sedation. Children have a more rapid metabolism of propofol than adults. Propofol has been shown to be safe and effective for Pediatric ED sedation in several studies.
Pearls on Propofol
Lopez M, Beltran G. Pediatric Procedural Sedation. Pediatric Emergency Medicine Reports. Dec 2008.
Category: Toxicology
Keywords: adverse drug reaction (PubMed Search)
Posted: 12/25/2008 by Fermin Barrueto
(Updated: 11/1/2024)
Click here to contact Fermin Barrueto
Watch out for tradename and generic name's of medications.
They can get the patient and yourself into trouble:
Classic example is my own case: Insert a central line in a patient - subclavian - and shortly after completion am alerted the patient's INR is 25. No adverse outcome but when I reviewed the med list, I did not see coumadin or warfarin and assumed I was in the clear. Patient was on jantoven.
Happy Holidays
Category: Toxicology
Keywords: Fat emulsion, intralipid, local anesthetic (PubMed Search)
Posted: 12/25/2008 by Ellen Lemkin, MD, PharmD
(Updated: 11/1/2024)
Click here to contact Ellen Lemkin, MD, PharmD
1. Felice, Kristen. Schumann, Heather. J Med Toxicol. 4(3):184-91, 2008 Sept 4(3):184-91, 2008 Sep.