American Academy of Emergency Medicine

Fact of the Day - February 2012

Brought to you by the AAEM Resident & Student Association (AAEM/RSA)

February 29, 2012

Clinical predictors of recurrent febrile seizure:Patient younger than 18 months at first convulsionTemperature lower than 40.0_C at first convulsionLess than 1 hour between onset of febrile illness and first convulsion First-degree relative with history of febrile seizure.

Emerg Med Clin N Am 29 (2011) 83-93

February 28, 2012

The principal clinical features of ethylene glycol poisoning are some degree of inebriation or alteration in consciousness, a profound metabolic acidosis, oxalate crystalluria, and acute renal failure.

NEJM. 2009;360:2216-23..

February 27, 2012

Poor communication has been shown to be consistently responsible for more than half of all medication errors that occur in hospitals during patient movement across transition points of care as well as up to 20% of all adverse events.

www.qmo.amedd.army.mil/ptsafety/MedRecon/Bibliography_ 2008 Dec 19.

February 26, 2012

Patients with a first-time seizure who have no known structural brain pathology, normal serum glucose and sodium levels, and a normal neurologic examination can be discharged from the ED with appropriate outpatient follow-up.

Emerg Med Clin N Am 29 (2011) 41-49

February 25, 2012

Differential diagnosis of vomiting in the pediatric age group may be a result of a range of causes, including GI (i.e., obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in overdoses), psychiatric disorders, strep throat, pregnancy or stress.

Pediatr Health. 2009;3(5):479-503

February 24, 2012

MRI seems to be the modality of choice in evaluation of select patients w in whom plain radiographs are negative and suspicion is high for occult fracture and offers high sensitivity and specificity for hip fracture.

Journal of Emerg Med. 2009;32(3):144-152

February 23, 2012

The evidence shows that currently available pain scales are focused primarily on the pain intensity at a single point in time, which leads to underestimation of the pain experience and undertreatment of painful conditions. At present, no data support the overall improvement in acute pain management in the ED by implementing pain scales.

Ask the expert, December 2009, Medscape

February 22, 2012

The treatment window for intravenous thrombolysis should be extended from 3 to 4.5 hours for stroke patients who meet European Cooperative Acute Stroke Study III (ECASS III) criteria, though not for those patients meeting the exclusion criterion of severe stroke as assessed clinically (e.g. National Institutes of Health Stroke Scale [NIHSS] > 25) and/or by appropriate imaging techniques.

Lancet Neurol. December 8, 2009(12):1095-102

February 21, 2012

The majority of spinal cord injuries (SCI), involving previously healthy young adults, result from trauma; 37% occur after road accidents, 42% follow falls, 11% are associated with sports and recreational activities, and 3% after assault.

Cont Edu Anaesth Crit Care & Pain. 2009;9(3):82-86

February 20, 2012

An initial serum lactate value > 4 mmol/L is associated with increased patient mortality - 27% mortality rate for septic patients with a lactate value > 4 mmol/L compared with < 5% for septic patients with lactate values < 2.5 mmol/L.

Emerg Med. 45:524-528

February 19, 2012

Non-contrast head CT scans reveal abnormalities ranging from 3% to 40% in patients with first-time seizure, which includes two-thirds with focal lesions and one-third with diffuse cerebral atrophy.

Emerg Med Clin N Am 29 (2011) 41-49

February 18, 2012

Ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis.

Lancet. 2009; 374(9686):293-300

February 17, 2012

During the first 6 hours of resuscitation, the goals of initial resuscitation of sepsis-induced hypoperfusion should include all of the following as one part of a treatment protocol: Central venous pressure (CVP): 8-12 mm Hg Mean arterial pressure (MAP) > 65 mm Hg Urine output > 0.5 mL/kg/hour Central venous (superior vena cava) or mixed venous oxygen saturation >70% or >65%, respectively

Intensive Care Med 2008 Jan;34(1):17-60

February 16, 2012

In Catheter-related bloodstream infections, empiric gram negative coverage is usually achieved with a third or fourth generation cephalosporin, carbapenem, or ß-lactam/ß-lactamase combination.

Clin Infect Dis. 2009;49:1-45.

February 15, 2012

The initial empiric antimicrobial therapy used to treat septic shock may be the most important determinant of whether a patient will survive to hospital discharge. Inappropriate therapy can reduce the chances of survival by fivefold or more.

Chest 2009;136:1237-1248.

February 14, 2012

Patients with ethylene glycol poisoning who have signs of renal injury should be followed with daily measurements of serum creatinine until their renal function returns to baseline.

NEJM. 2009;360:2216-23.

February 13, 2012

New-onset AF leads to adverse outcomes in patients with CHF through adverse haemodynamic effects such as loss of atrial contraction, rapid ventricular rates, loss of atrio-ventricular synchrony, and an irregular RR interval leading to a decrease in cardiac output.

Europace. 2009;11(10):1295-1300.

February 12, 2012

Data from the recent EuroHeart failure survey have reported an AF prevalence of 34% in patients with CHF with a further 9% diagnosed with new-onset AF during hospitalization.

Europace. 2009;11(10):1295-1300.

February 11, 2012

Compared with procedural sedation with propofol alone, the combination of ketamine and propofoldid not reduce the incidence of respiratory depression but resulted in greater provider satisfaction, less propofol administration, and perhaps better sedation quality.

Emerg Med. 2011;57:435-441

February 10, 2012

The five classic stages of iron toxicity are include: 1) gastrointestinal toxicity with variable clinical and histologic features , 2) apparent stability, 3) shock and acidosis of multiple etiologies (the common thread in all fatal iron exposures),4) hepatotoxicity, and 5) gastrointestinal scarring.

Pediatr Crit Care Med 2009 Vol. 10, No. 3

February 09, 2012

No increase risk of death was observed in a large unselected population-based cohort of patients discharged with the first-time atrial fibrillation and subsequently treated with flecainide, propafenone, sotalol, or amiodarone.

Europace. 2009;11(7):886-891.

February 08, 2012

Implementation of the Canadian C-Spine Rule led to a significant decrease in imaging without injuries being missed or patient morbidity.

BMJ. 2009; 339:b4146

February 07, 2012

Hemodynamic criteria for cardiogenic shock are sustained hypotension (systolic blood pressure <90 mm Hg for at least 30 min) and a reduced cardiac index (<2.2 L/min/m2) in the presence of elevated pulmonary capillary occlusion pressure (>15 mm Hg).

Myocardial Disease and Cardiomyopathies, Medscape, September 2008.

February 06, 2012

A reduction in door-to-balloon time from 90 minutes to 60 minutes was associated with 0.8% lower mortality, and a reduction from 60 minutes to 30 minutes was associated with a 0.5% lower mortality.

BMJ. May 19, 2009;338:b1807

February 05, 2012

In patients receiving fibrinolysis for AMI, the overall incidence of hemorrhagic complications is about 10%, and the incidence of intracranial hemorrhage is about 0.8%. comparing to patients receiving fibrinolysis for acute ischemic stroke, the incidence of intracranial hemorrhage is higher, approximately 6%.

Stroke. May 2007;38(5):1655-711

February 04, 2012

The recommended dose of alteplase for acute ischemic stroke is 0.9 mg/kg (maximum of 90 mg) infused over 60 minutes, with 10% of the total dose administered as an initial IV bolus over 1 minute.

Stroke. May 2007;38(5):1655-711

February 03, 2012

In selected patients with extensive acute proximal DVT (eg, iliofemoral DVT, upper extremity DVT, symptoms <14 d, good functional status, life expectancy >1 y) with low risk of bleeding, catheter-directed thrombolysis (CDT) may be used to reduce symptoms and post thrombotic morbidity if appropriate resources are available.

Chest. June 2008;133(6 Suppl):71S-109S.

February 02, 2012

When compared with ketamine alone for pediatric orthopedic reductions, the combination of ketamine and propofol produced slightly faster recoveries while also demonstrating less vomiting, higher satisfaction scores, and similar efficacy and airway complications.

Emerg Med. 2011;57:425-433

February 01, 2012

Few patients experience a major vascular event after discharge home with a diagnosis of dizziness or vertigo, with a stroke occurring in less than 1 in 500 patients within the first month.

Emerg Med. 2011;57:34-41.