Category: Cardiology
Keywords: hyperkalemia, treatment, management (PubMed Search)
Posted: 11/30/2008 by Amal Mattu, MD
(Updated: 11/26/2024)
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Category: Pediatrics
Keywords: SIDS (PubMed Search)
Posted: 11/28/2008 by Don Van Wie, DO
(Updated: 11/26/2024)
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SIDS
Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than 1 year that remains unexplained after a thorough case investigation, including the performance of a complete autopsy, examination of the scene of death, and review of the clinical history.
SIDS is the single most common cause of death in infants aged 1 mo to 1 yr
Education is key for prevention of these tragic events:
Following the "Back to Sleep" campaign, federal SIDS researchers have conducted annual surveys to examine how infant sleep practices and SIDS rates have changed. The rate of prone sleeping for infants decreased from approximately 75% in 1992 to a low of 11.3% in 2002
Since 1992, SIDS rates have fallen approximately 58%. In 2002, the National Center for Health Statistics reported a total of 2295 SIDS deaths nationwide for a SIDS rate in the United States of 0.51 per 1000 live births.
Bed-sharing may lead to compromise of the infants' airway because the infant may be suffocated by soft, loose bedding or a sleeping adult.
Cosleeping on a couch or sofa is associated with an unusually high risk for SIDS and should be avoided.
Category: Toxicology
Keywords: tryptophan (PubMed Search)
Posted: 11/28/2008 by Fermin Barrueto
(Updated: 11/26/2024)
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Tryptophan - a precursor to melatonin, it is often blamed for the post prandial coma that many go into after a big turkey dinner. Never mind the 5000 kcals that was consumed during the meal. The supplement really doesn't help with sleeping. Interestingly, turkey isn't even in the top 10 or 20 of foods that contain tryptophan. The top five are:
1) Game meat (Elk): 746 mg of tryptophan
2) Seaweed (Spirulina): 736 mg of tryptophan
3) Spinach: 690 mg of tryptophan
4) Egg White: 673 mg of tryptophan
5) Soy protein: 630 mg of tryptophan
Supplements of L-tryptophan have been contaminated with a compound that has been associated with eosinophilia myalgia syndrome.
Category: Critical Care
Keywords: stress related mucosal injury, histamine antagonists, proton pump inhibitors, sucralfate (PubMed Search)
Posted: 11/25/2008 by Mike Winters, MBA, MD
(Updated: 11/26/2024)
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Stress Related Mucosal Injury (SRMI)
Category: Vascular
Keywords: Hypertension (PubMed Search)
Posted: 11/24/2008 by Rob Rogers, MD
(Updated: 11/26/2024)
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What Hypertensive Patient Needs a Workup for End-Organ Damage?
Ah, the age old question...which hypertensive patients need an ED workup for end-organ damage? The "workup" for patients includes renal function, urinalysis, CXR, ECG, etc.
Some pearls regarding working patients up:
Category: Obstetrics & Gynecology
Posted: 11/23/2008 by Michael Bond, MD
(Updated: 11/26/2024)
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Third Trimester Bleeding:
Category: Cardiology
Keywords: myocardial infarction, delirium, confusion (PubMed Search)
Posted: 11/23/2008 by Amal Mattu, MD
(Updated: 11/26/2024)
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Category: Toxicology
Keywords: cardiotoxicity, marcaine, bupivacaine (PubMed Search)
Posted: 11/20/2008 by Fermin Barrueto
(Updated: 11/26/2024)
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Category: Neurology
Keywords: phenytoin, dilantin, seizure (PubMed Search)
Posted: 11/19/2008 by Aisha Liferidge, MD
(Updated: 11/26/2024)
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Category: Critical Care
Keywords: dopamine, hemodynamic medication, vasopressors (PubMed Search)
Posted: 11/18/2008 by Mike Winters, MBA, MD
(Updated: 11/26/2024)
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Dopamine in the ED
Marino PL. Hemodynamic drugs. In: The Little ICU Book of Facts and Formulas. 2009 Ed. Lippincott Williams & Wilkins, Philadelphia, PA.
Category: Infectious Disease
Keywords: Pneumonia (PubMed Search)
Posted: 11/18/2008 by Rob Rogers, MD
(Updated: 11/26/2024)
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Healthcare Associated Pneumonia (HCAP)....why is this important for the emergency physician?
Most of us are very familiar with the types of pneumonias commonly seen in clinical practice: community-acquired pneumonia (CAP), hospital-acquired pneumonia(HAP), and ventilator-associated pneumonia (VAP). But, some may not be that aware of a relatively newer type of pneumonia that has been well-defined, healthcare-associated pnemonia (HCAP). Experts in infectious disease and critical care now say that we (the ED) should be assessing ALL pneumonia patients for HCAP risk factors.
Why care, you ask?
Risk factors: (most are common sense)
Treatment:
Category: Cardiology
Keywords: aortic dissection, aortic aneurysm, cardiac arrest, ultrasound (PubMed Search)
Posted: 11/16/2008 by Amal Mattu, MD
(Updated: 11/26/2024)
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Death from ruptured aortic aneurysms and thoracic aortic dissection has a few key features that often help in distinguishing these entities from other causes of rapid decompensation and sudden death:
1. These aortic disasters have a tendency to present with hypotension but without necessarily any specific complaints of pain (in contrast to common teaching).
2. These aortic disasters tend usually to produce PEA as the initial arrest rhythm.
3. These aortic disasters are often diagnosable on bedside ultrasound (AAA seen when scanning the abdomen; dissections frequently produce pericardial tamponade as they dissect backwards into the pericardial sack).
ALWAYS take a look at a patient's aorta and pericardium with the ultrasound when that patient presents in extremis or in cardiac arrest. The results can help make some critical diagnostic and therapeutic decisions.
[recent article related to this topic: Pierce LC, Courtney DM. Clinical characteristics of aortic aneurysm and dissection as a cause of sudden death in outpatients. Am J Emerg Med 2008;26:1042-1046.]
Category: Misc
Keywords: Glucometer, Accuracy (PubMed Search)
Posted: 11/15/2008 by Michael Bond, MD
(Updated: 11/26/2024)
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The glucometer is one of the devices that we quickly reach for in the management of our unresponsive patients, diabetics and in the critically ill. Recently, I noticed that our Roche Accu-Check has a big sticker on the case stating that results could be affected by therapies that alter the metabolism of galactose, maltose, and xylose. Since this was a big hole in my fund of knowledge I decided to look up what else affects the accuracy of glucometers.
Now, Dr. Winters already warned used about the inaccuracy of bedside glucometer readings in the critically ill, but what about the patient that is not septic and/or in shock.
Substances/Drugs that have been reported to affect the accuracy of glucometers are:
Anemia also results in higher values, and a capillary blood sample can differ from venous blood by as much as 70mg/dL.
Most errors are more significant when dealing with hypoglycemia.
So the moral of the story is be careful with a bedside glucometer when the reading is low, as the venous blood sample sent to the lab may return even lower. Error on the side of treating the patient with glucose.
Fahy BG, Coursin DB. Critical glucose control: the devil is in the details. Mayo Clin Proc. Apr 2008;83(4):394-397.
Category: Neurology
Keywords: status epilepticus, seizure (PubMed Search)
Posted: 11/13/2008 by Aisha Liferidge, MD
(Updated: 11/26/2024)
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Category: Toxicology
Keywords: opioid, opiate, allergy, hypersensitivity (PubMed Search)
Posted: 11/5/2008 by Bryan Hayes, PharmD
(Updated: 11/26/2024)
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How many times have you had a patient with an allergy to codeine described as stomach upset? Or how about a rash with morphine (probably secondary to histamine release)? True anaphylactic reactions to opioids are very rare (< 1%). But what happens when you have a patient with a true allergy, but still need to give an opioid? No problem, you just need to choose one that is structurally different.
All of the group 1 and 2 agents are structurally very similar to each other and should not be given if a true allergy exists to any other natural or semi-synthetic derivative. Group 3 agents have structures different enough that they can be given to a patient intolerant to the natural or semi-synthetics without fear of cross reactivity. They are also very different from others in this same group.
Category: Critical Care
Keywords: seizure, metabolic (PubMed Search)
Posted: 11/11/2008 by Mike Winters, MBA, MD
(Updated: 11/26/2024)
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Seizures in the Critically Ill
Mirski MA, Varelas PN. Seizures and status epilepticus in the critically ill. Crit Care Clin 2008;24:115-147.
Category: Vascular
Keywords: hypertension (PubMed Search)
Posted: 11/10/2008 by Rob Rogers, MD
(Updated: 11/26/2024)
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Category: Cardiology
Keywords: low voltage, electrocardiography (PubMed Search)
Posted: 11/9/2008 by Amal Mattu, MD
(Updated: 11/26/2024)
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Category: Orthopedics
Keywords: maisonneuve, tibia, fibula, fracture, ankle, orthopedic (PubMed Search)
Posted: 11/2/2008 by Dan Lemkin, MS, MD
(Updated: 11/26/2024)
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A maisonneuve fracture is a fracture dislocation resulting from external rotational forces to ankle -- through interosseous ligament to fibula.
If stability is questionable, orthopedic evaluation under anesthesia is required. Additionally always consider compartment syndrome. Do not rely on Kanduval's signs (pain, paraesthesia, pallor, poikilothermia, pulselessness) - "... with the exception of pain and paraesthesia, these traditional signs are not reliable." Emergent orthopedic consultation and compartment pressure assessment should be performed. (see attached photos)
Category: Toxicology
Keywords: Drugs of abuse, salvia, sage (PubMed Search)
Posted: 11/6/2008 by Ellen Lemkin, MD, PharmD
(Updated: 11/26/2024)
Click here to contact Ellen Lemkin, MD, PharmD
This is a psychoactive herb which can induce strong dissociative effects by stimulation of the kappa receptor. It has become increasingly well known and available in modern culture, and popularized by YouTube Salvia (also known as Sage, Diviner's Sage, Magic Mint, or Sally D) is usually smoked, but can be chewed or ingested.
The high it produces is very intense, but lasts only approximately 10 minutes. Currently many states have enacted legislation against it, including Fla, IL, KA, MI, MO, ND, OK and VA, but it is available over the internet.
The following video demonstrates clinical effects of drug.
Although it is amusing, this is not meant to condone use.
(if you can not view the embeded video here is the link)
http://www.youtube.com/watch?v=w6dgXX0ytSo