Fact of the Day - August 2011
Brought to you by the AAEM Resident & Student Association (AAEM/RSA)August 31, 2011
Salicylate-induced pulmonary edema (SIPE) should be considered in patients who present with pulmonary edema and neurological changes, anion-gap metabolic acidosis, or possible sepsis.
South Med J. 2011;104(3):225-232
August 30, 2011
Myoclonus in patients receiving etomidate usually lasts for less than 1 minute despite its dramatic presentation which can resemble seizure activity.
als of EM, Vol. 45, pg. 184
August 29, 2011
A randomized, placebo-controlled, double-blind trial at 146 centers in 9 European countries failed to demonstrate any benefit of lowering blood pressure in acute stroke and in fact showed a trend toward harm.
AccessMedicine from McGraw-Hill © 2011
August 28, 2011
If rtPA is to be used for a PE, a single dose of 100 mg over 2 hours followed by unfractionated heparin is suggested.
Journal of Emerg Med. June 2009
August 27, 2011
Approximately 33% of children experience rupture of their appendix prior to operative treatment.
AMA,298 (4):438-451
August 26, 2011
The most commonly reported adverse effects of IV acetylcysteine are anaphylactoid reactions (rash, pruritus, angioedema, bronchospasm, and hypotension) which occur in about 15% of patients within 2 hours after the initial infusion.
NEJM;359(3):285
August 25, 2011
The fluorescence of urine under ultraviolet light may aid in the early identification of ethylene glycol poisoning.
NEJM;Vol. 356:611
August 24, 2011
AAEM Oral Board Review Course,Las Vegas
August 23, 2011
With primary PCI the success rate is higher than 90%, whereas current fibrinolytic therapy leads to full reperfusion in only 50 to 55% of patients with ST-segment elevation myocardial infarction.
NEJM, June 25, 2009, pg. 2779
August 22, 2011
Troponin elevation can be detected as early as 2-4 hours after the onset of symptoms but may be delayed for 8-12 hours. After MI, the increased level may persist for 5 to 14 days.
als of EM, Vol. 51., pg. 591
August 21, 2011
PURSUIT Risk Factors For Acute Myocardial Infarction• Age• Gender• Highest Canadian Cardiovascular Society angina classification inprevious 6 weeks• Heart rate• Systolic blood pressure• Signs of heart failure (eg, rales)• ST depression on presenting electrocardiogram
August 20, 2011
Initial treatment of symptomatic carotid artery dissection is unfractionated heparin, used to prevent thrombus formation on the injured endothelial surface and thereby prevent embolization.
Mayo Clin Proc, Vol. 81, pg. 1394
August 19, 2011
Tetanus is defined by the acute onset of hypertonia or by painful muscular contractions (usually of the muscles of the jaw & neck) and generalized muscle spasms without other apparent medical cause.
Journal of Emerg Med. Vol. 32, pg. 267
August 18, 2011
The Brugada syndrome is estimated to be responsible for 4% of all sudden deaths and up to 20% of deaths in patients with structurally normal hearts.
als of Int. Med, Vol. 148, pg. 82
August 17, 2011
Hypoglycemia results in a focal neurological deficit by hypoglycemic-mediated vasospasm, structural narrowing of selective cerebral vessels thus resulting in more pronounced localized effects of hypoglycemia, and vulnerability of selective neurons .
Am J EM, Vol. 23, pg.823
August 16, 2011
Studies demonstrate that more than 85% of patients with a self-reported history of penicillin allergy have negative penicillin skin test results.
als of EM, July 2009, pg. 73
August 15, 2011
Thyroid storm is a life threatening condition whose features include fever, tachycardia out of proportion to the fever, confusion, agitation, nausea and vomiting, hypertension, congestive cardiac failure, increased alanine transaminase, alkaline phosphatase and bilirubin, with biochemical evidence of thyrotoxicosis.
August 14, 2011
A recent study of 985 febrile children under age 2 years found that the sensitivity of a urinalysis for predicting a positive urine culture result was only 64% (the specificity was 91%).
Am J Emerg Med 2009;27:930-2.
August 13, 2011
Misplacement of the catheter tip in the ipsilateral internal jugular vein instead of the SVC is a common complication of subclavian central venous catheter placement - it occurs in approximately 5% of patients.
NEJM. 2008;358:1758-9.
August 12, 2011
A retrospective study of 1684 patients with acute MI found that 12% of those presenting to the ED had ECG findings indicative of ischemia that were missed by emergency clinicians.
EBMedicine.net .January 2010.
August 11, 2011
1/2 - 1/3 of patients with acute-onset AF will experience spontaneous conversion to NSR within 24 hours.
Mayo Clin Proc 2009;84:643-62.
August 10, 2011
The best available evidence, though limited, suggests that the Epley maneuver appears to be most likely to result in symptomatic relief in patients with benign positional vertigo and should be considered first line treatment.
Cochrane Database of Systematic Reviews, Issue 3, 2009
August 09, 2011
The acute retroviral syndrome - acute primary HIV infection - is characterized by nonspecific symptoms that is often misdiagnosed as a common viral illness with Aseptic meningitis being reported in 24% of cases of acute HIV infection.
NEJM. 2009;360:1540-1548
August 08, 2011
Fascicular VT occurs in hemodynamically stable young patients without any underlying ischemic heart disease with ECG showing a right bundle-branch block pattern and left-axis deviation with a relatively narrow QRS complex (100-140 msec).
Am J Emerg Med 2007; 25: 572-575.
August 07, 2011
In the International Registry of Aortic Dissection study, syncope occurred in more than 12% of patients with type A dissection and 2.2% of these patients did not have pain or other neurological findings.
JAMA 2000;283:897-903.
August 06, 2011
Staphylococci (S. aureus and coagulase-negative staphylococcus species) account for more than half of cases of prosthetic-hip and prosthetic-knee infection.
NEJM. Volume 361:787-794 August 20, 2009
August 05, 2011
The 2008 American College of Chest Physicians guidelines recommend catheter-directed pharmacothrombolysis, mechanical thrombectomy, and stent placement or surgical thrombectomy in patients with ilio-femoral DVT.
Chest. 2008;133:454S-545S
August 04, 2011
Blue toe syndrome refers to acute digital ischemia caused by athero-microembolism and is associated with cool, painful cyanotic toes in the presence of palpable distal pulses.
Rosen's Emergency Medicine: Concepts and Clinical Practice, 6th. Ed. © C.V. Mosby
August 03, 2011
CT and MRI studies have undermined the concept of cricoid pressure and have demonstrated that cricoid pressure commonly causes esophageal displacement instead of occlusion.
als of EM Vol. 47:548
August 02, 2011
Codeine is a prodrug that exerts its analgesic effects after metabolism to morphine.
Mayo Clin Proc, July 2009, pg. 613
August 01, 2011
Baker's cysts may be seen in patients with rheumatoid arthritis, in whom they consist of a synovium-lined sac that is continuous with the joint space. Symptoms of a Baker's cyst, especially if it ruptures, may mimic those of venous thrombosis.
NEJM. Volume 361:1098. September 10, 2009
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