Category: Critical Care
Keywords: intra-aortic balloon pump counterpulsation, cardiogenic shock (PubMed Search)
Posted: 4/29/2008 by Mike Winters, MBA, MD
(Updated: 10/31/2024)
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Intra-aortic balloon pump counterpulsation
Kim JT, Lee JR, Kim JK, et al. The carina as a useful radiographic landmark for positioning the intra-aortic balloon pump. Anesth & Analg 2007;105:735-8.
Category: Misc
Keywords: Leukemia (PubMed Search)
Posted: 4/28/2008 by Rob Rogers, MD
(Updated: 10/31/2024)
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Suspected Acute Leukemia in the ED
Key ED Interventions for patients with astronomically high WBC counts:
Category: Cardiology
Keywords: internal cardioverter defibrillator, infection (PubMed Search)
Posted: 4/27/2008 by Amal Mattu, MD
(Updated: 10/31/2024)
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Infections occur in up to 8-9% of ICD sites. Early infections usually occur within the first 2 months of placement and are associated with typical findings...redness, tenderness, systemic symptoms, etc. Late infections, however, are often associated with nothing more than JUST pain.
Lack of diagnosis of ICD site infections is associated with a mortality > 50%.
When infected, the entire ICD (including wires) must be replaced.
The most commor organisms associated with ICD infections are Staph and Strep. Treat them all with vancomycin.
Category: Orthopedics
Keywords: Turf Toe (PubMed Search)
Posted: 4/27/2008 by Michael Bond, MD
(Updated: 10/31/2024)
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Turf Toe:
Most commonly seen in atheletes who compete on artificial turf. Presents as pain over the 1st Metatarsalphalangeal (MTP) joint.
Category: Pediatrics
Keywords: Inuries, Falls, Poisoning, Drowning (PubMed Search)
Posted: 4/25/2008 by Sean Fox, MD
(Updated: 10/31/2024)
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Pediatric Accidental Non-Fatal Injuries
Karin A. Mack, Julie Gilchrist, Michael F. Ballesteros. Injuries Among Infants Treated in Emergency Departments in the United States, 2001—2004. Pediatrics; May 1 2008; 121 (5), 930-937.
Category: Toxicology
Keywords: amanita, mushrooms, liver (PubMed Search)
Posted: 4/24/2008 by Fermin Barrueto
(Updated: 10/31/2024)
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How to recognize a truly toxic mushroom ingestion (remember one mushroom can be lethal!):
1) Onset of GI symptoms within 3 hours from time of ingestion: USUALLY NONTOXIC
- Control nausea and vomiting
- Look for toxidrome: hallucinations, muscarinic symptoms, lethargy
2) Onset of GI symptoms greater than 5 hrs is associated with more toxic mushrooms
- High degree of suspicion for a cyclopeptide mushroom (Amanita phylloides)
- Follow liver enzymes and consier referral to liver transplant center
Category: Critical Care
Keywords: glucose, critically ill (PubMed Search)
Posted: 4/22/2008 by Mike Winters, MBA, MD
(Updated: 10/31/2024)
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Bedside Glucometry in the Critically Ill
Desachy A, et al. Accuracy of Bedside Glucometry in Critically Ill Patients: Influence of Clinical Characteristics and Perfusion Index. Mayo Clin Proc 2008;83:400-5.
Category: Vascular
Keywords: hemorrhage (PubMed Search)
Posted: 4/21/2008 by Rob Rogers, MD
(Updated: 10/31/2024)
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Hemorrhage Volume on Head CT
Ever wanted to speak the same language as our neurosurgical colleagues? Ever wonder what they are doing, calculating, or thinking about as they look at the head CT of the large intracranial hemorrhage?
Most of the neurosurgeons want to know basic information about patients with head bleeds. One thing they always calculate is the hemorrhage volume...i.e. how many mLs of blood are in the bleed? This can be easily done in the ED by using the following formula: called the ABC formula.
A X B X C/2 X 0.6= mL of blood
A= largest width of the bleed (in cm)
B=largest width perpindicular to A
C=number of cuts you see blood on
So, if A=2cm, B=2cm and the bleed is seen on 3 cuts.....
2 X 2 X 3/2 X 0.6=3.6 mL of blood (not very much in the opinion of a neurosurgeon)
Most of the big bleeds that neurosurgeons drain or take to the OR are 50 cc or so. So, when you call a neurosurgeon and tell them that the patient has 60 mLs of blood, you will definitely get their attention.
Category: Cardiology
Keywords: internal cardioverter-defibrillator, shock, defibrillation (PubMed Search)
Posted: 4/20/2008 by Amal Mattu, MD
(Updated: 10/31/2024)
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Patients with ICDs presenting to the ED reporting that their ICD fired once do not need mandatory ICD interrogation, admission or an extensive ED workup purely based on the single shock. A workup should be initiated purely based on any other associated symptoms...chest pain, dyspnea, etc. If the patient was doing well and had no other symptoms prior to the shock, the patient should simply have close follow up with cardiology.
Patients presenting after multiple shocks, on the other hand, do need a workup and emergent ICD interrogation (most of these cases also are later deemed inappropriate shocks).
Category: Orthopedics
Keywords: Achilles Tendon Rupture (PubMed Search)
Posted: 4/19/2008 by Michael Bond, MD
(Updated: 10/31/2024)
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Achilles Tendon Rupture
This addition was sent in my Dr. Andrew Milstein:
Thanks for the Orthopedics update. A few pearls for Achilles Tendon Rupture --> often these patients may present like a typical ankle sprain patient and are placed in a hallway chair. You can't do an adequate Thompson Test while someone is sitting in a chair. If you're concerned, lay them down on a stretcher to do the test.
Category: Pediatrics
Keywords: Acute Chest Syndrome, Sickle Cell Disease, Fever, Chest Pain (PubMed Search)
Posted: 4/18/2008 by Sean Fox, MD
(Updated: 10/31/2024)
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Acute Chest Syndrome
NHLBI. Acute chest syndrome and other pulmonary complications. Management of Sickle Cell Disease. June 2003; 25 – 29. http://www.nhlbi.nih.gov/health/prof/blood/sickle/index.htm.
Kathleen Ryan, RN, MPH, Anju Chawla, MD and Matthew Heeney, MD. Management of Acute Chest Syndrome in Sickle Cell Disease. New England Pediatric Sickle Cell Consortium. 2005.
Category: Toxicology
Keywords: dialysis, lithium salicylate (PubMed Search)
Posted: 4/17/2008 by Fermin Barrueto
(Updated: 10/31/2024)
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Category: Neurology
Keywords: intracranial hemorrhage, ich, intracranial hemorrhage expansion (PubMed Search)
Posted: 4/17/2008 by Aisha Liferidge, MD
(Updated: 10/31/2024)
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Category: Vascular
Posted: 4/15/2008 by Rob Rogers, MD
(Updated: 10/31/2024)
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PEA Arrest...Look for AAA rupture and Cardiac Tamponade
If a patient presents in cardiac arrest (particularly PEA), consider the following diagnoses in addition to the causes commonly taught in ACLS:
A 2004 study in Resuscitation by Meron et al. showed the following:
Take home point for the emergency physician:
Meron, et al. Resuscitation 2004
Category: Critical Care
Keywords: vasopressin, septic shock (PubMed Search)
Posted: 4/15/2008 by Mike Winters, MBA, MD
(Updated: 10/31/2024)
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Vasopressin for Sepsis
Category: Cardiology
Keywords: internal cardioverter defibrillator (PubMed Search)
Posted: 4/13/2008 by Amal Mattu, MD
(Updated: 10/31/2024)
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ICD shocks are often associated with ST segment elevation and even positive troponin levels that can simulate acute MI. So how do you know if the patient experienced an acute MI with VF that triggered the ICD shock? Or if there simply was an aberrant ICD shock that triggered STE with positive troponins?
STE that is due purely to the ICD shock generally resolves after only 15-20 minutes. Persistent STE beyond that time should be assumed to be true ischemia.
Troponin elevations that are due purely to an ICD shock are usually mild and normalize within 24 hours. Huge troponin elevations and those that last beyond 24 hours should be assumed to be caused by true infarction.
Category: Gastrointestional
Keywords: Pancreatitis (PubMed Search)
Posted: 4/12/2008 by Michael Bond, MD
(Updated: 10/31/2024)
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Some simple facts about Pancreatitis:
Category: Pediatrics
Keywords: Neonatal Fever, HSV, Acyclovir (PubMed Search)
Posted: 4/11/2008 by Sean Fox, MD
(Updated: 10/31/2024)
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Consider HSV
Whitley R, Davis EA, Suppapanya N. Incidence of neonatal herpes simplex virus infections in a managed-care population. Sex Transm Dis. 2007 Sep;34(9):704-8.
Benson PC, Swadron SP. Empiric acyclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis. Ann Emerg Med. 2006 Jan;47(1):100-5. Epub 2005 Nov 8.
Category: Toxicology
Keywords: naloxone, opioids (PubMed Search)
Posted: 4/10/2008 by Fermin Barrueto
(Updated: 10/31/2024)
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1) No IV - Try naloxone in a nebulizer - Dose: 2-4 mg and saline in your nebulizer container.
2) When using naloxone IV, use following dose: 0.05 mg IV - you will find it reverses the respiratory depression without inducing withdrawal. Anesthesia doses naloxone in micrograms, we often overdose our patients. The effect is delayed and not as pronounced as the 0.4 mg blast that causes nausea, vomiting, diarrhea, agitation - all not desirable in the ED.
Category: Neurology
Keywords: flumazenil. seizure, drug overdose (PubMed Search)
Posted: 4/9/2008 by Aisha Liferidge, MD
(Updated: 10/31/2024)
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Williams, JS. "Flumazenil Revisited."