Fact of the Day - June 2013
Brought to you by the AAEM Resident & Student Association (AAEM/RSA)June 30, 2013
Class III shock is the first class in which there is a drop in the systolic blood pressure below 90mmHg.
Schofer JM, Mattu A, Colletti JE, Gray EA, Rogers RL, Shih RD, eds. Emergency Medicine: A Focused Review of the Core Curriculum Milwaukee, WI: American Academy of Emergency Medicine; 2008.
June 30, 2013
The overall prevalence of drug-related ED visits among lifetime drug users was 1.8%; for those with a lifetime drug use disorder, 3.7%. Persons with heroin dependence and inhalant dependence had the highest rates of ED visits, and marijuana dependence was associated with the lowest rates.
American Journal of Emergency Medicine (2011) 29, 704–710
June 29, 2013
Left ventricular (LV) pump failure has emerged as the leading cause of mortality in acute coronary syndromes (ACS), with overall ACS mortality ranging from 3% to 7% during the index hospitalization.
EMCC /EB Medicine.net, 2011, Volume 1, Number 4
June 28, 2013
tPA is the first medication to be considered for the patient with spontaneous dissections and evidence of acute stroke. It is given in concordance with guidelines for typical ischemic stroke.
Ebmedicine.net 2012 Vol. 14 (4)
June 27, 2013
A systematic review showed that Acetazolamide is effective for the prevention of acute mountain sickness but may be associated with paresthesias. Sumatriptan and gabapentin are beneficial but require further study.
Ann Emerg Med. 2012; 59:307-317
June 26, 2013
SCIWORA may result from self-reducing intersegment deformity to the spinal cord or from injury to the vascular supply of the cord. It is more common in children because their bony spinal columns are more elastic.
JEM, Vol. 41, pg. 252
June 25, 2013
Desaturation to below 70% puts patients at risk for dysrhythmia, hemodynamic decompensation, hypoxic brain injury, and death.
Ann Emerg Med. 2012;59:165-175
June 24, 2013
The 4 metabolic derangements associated with the Tumor Lysis Syndrome: Hyperuricemia, Hyperphosphatemia, Hyperkalemia, and Hypocalcemia.
Mayo Clin Proc, Vol. 81, pg. 838
June 23, 2013
The deep sulcus sign, which is characterized by a deep, lucent, ipsilateral costophrenic angle on supine chest radiography, is an indirect sign of a pneumothorax.
NEJM, 2/9/12, pg. 552
June 22, 2013
Risk-stratification has a vital role in the emergency management of ACS. The GRACE score for predicting in-hospital mortality is calculated on admission, with a score between 1 and 258. Points are assigned for the following 8 variables:
- Older age
- Lower systolic blood pressure
- Increased heart rate
- Elevated creatinine
- Congestive heart failure Killip Class
- Cardiac arrest at presentation
- ST-segment deviation
- Elevated cardiac enzymes
EBmedicine.net, April 2012
June 21, 2013
The reported 30-day mortality for patients presenting to the ED with an acute myocardial infarction who receive a misdiagnosis is 9%.
Ann of EM, 2/12, pg. 115
June 20, 2013
Alcohol withdrawal produces a hyperautonomic state that can range in severity from mild tachycardia and tremor to hallucinations, seizures or frank delirium tremens, and death. Signs and symptoms of withdrawal are most likely to reach peak intensity 48 hours after a last drink, but there is wide variation in the onset, severity, and duration of symptoms.
American Journal of Emergency Medicine (2011) 29, 382–385
June 19, 2013
The presence of lethargy, grunting, and a PaCO2 of 65 mm Hg or greater at initial presentation in the ED were predictive for the subsequent need for mechanical ventilation in previouslyhealthy, RSV-infected children admitted to the PICU.
American Journal of Emergency Medicine (2011) 29, 168–173
June 18, 2013
A greater ST elevation in lead III than lead II is often indicative of a right coronary artery occlusion manifesting as an RV infarct.
Mayo Clin Proc, Vol. 85, pg. e52
June 17, 2013
A retrospective propensity-score-matched case-control study showed that Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia. Treatment failure rates were similar between the two drugs, but adverse events were more common with nafcillin.
Antimicrob Agents Chemother 2011 Nov 55:5122
June 16, 2013
About half of the cases of postpartum eclampsia occur within 48 hours after delivery, and the remainder occur between 2 days and 4 weeks after delivery (delayed postpartum eclampsia).
NEJM, Vol. 360, pg. 1126
June 15, 2013
Simple UTIs (eg, cystitis in women) can be treated with 3 days of antibiotics; however, UTIs in men are considered “complicated” by definition and warrant at least 7 days of antibiotic therapy.
Mayo Clin Proc, Vol. 86, pg. 557
June 14, 2013
Nebulized racemic epinephrine delivered by helium-oxygen followed by helium-oxygen inhalation therapy delivered by HFNC was associated with a greater degree of clinical improvement compared with that delivered by oxygen among infants with bronchiolitis.
Arch Pediatr Adolesc Med 2011 Dec 165:1115
June 13, 2013
The differential diagnosis of a peripherally enhancing brain lesion should always include the following neoplastic processes: metastatic tumors, primary glial tumors, and primary lymphoma of the central nervous system.
N Engl J Med 2012;366:745-755
June 12, 2013
Acute sinusitis is most commonly viral in origin (eg, the common cold) and is estimated to occur 2-5 times per year in an average adult. Bacterial infection is thought to complicate only a very small percentage of cases: 0.5%-2.0%.
Mayo Clin Proc, 5/11, pg. 427
June 11, 2013
Alcohol produces seizures in patients with or without underlying foci by:
- By partial or absolute withdrawal of alcohol after a period of chronic intake.
- By an acute alcohol-related metabolic brain disorder (eg, hypoglycemia, hyponatremia).
- By creating a situation leading to cerebral trauma.
- By precipitating seizures in patients with epilepsy.
- By persistent heavy intake of alcohol, independent of alcohol withdrawal.
Emerg Med Clin N Am 29 (2011) 117–124
June 10, 2013
The cause of most cases of acute-onset monocular floaters and/or flashes is posterior vitreous detachment.
JAMA, Vol. 302, pg. 2243
June 09, 2013
Tibial intraosseous access is found to have the highest first-attempt success for vascular access and the most rapid time to vascular access during out-of-hospital cardiac arrest compared with peripheral intravenous and humeral intraosseous access.
Ann Emerg Med. 2011;58:509-516
June 08, 2013
Kline et al published a prospective study in which clinicians used the PERC rule as part of standard care for 115 patients who were followed for outcomes at 2 weeks. Sixty-five of the 115 patients were PERC negative, and zero (0/65; 95% confidence interval 0% to 5.5%) had an outcome of pulmonary embolism.
Ann Emerg Med. 2012;59: 84-85
June 07, 2013
The prediction instrument for endocarditis in febrile injection drug users that used combination of best criteria including tachycardia, lack of skin infection, and cardiac murmur had a sensitivity of 100% (95% confidence interval, 84%-100%) and negative predictive value of 100% (95% confidence interval, 88%-100%).
American Journal of Emergency Medicine (2011) 29, 894–898
June 06, 2013
Ischemic bowel can be caused by 1 of 4 mechanisms: arterial thrombosis, arterial embolism, venous thrombosis, or non-occlusive mesenteric ischemia (NOMI). Survival rates vary depending on the mechanism. Overall mortality is as high as 60% to 80%, especially with delays in diagnosis or presentation of greater than 24 hours.
Emerg Med Clin N Am 29 (2011)
June 05, 2013
Current data suggest there is no difference between expectant care, misoprostol, and surgical treatment for incomplete miscarriage at less than 13 weeks of gestation.
Annals of Emergency Medicine , 2012; 59(4)
June 04, 2013
The diagnosis of RV infarction portends a poor prognosis for patients, with mortality increased by as much as 50% in patients who have LV infarcts that also involve the RV.
Mayo Clin Proc, 8/10, pg. e52
June 03, 2013
When Rh-positive fetal blood enters the circulation of an Rh-negative mother, maternal anti-D antibodies are produced. This process, called sensitization or alloimmunization, usually has no adverse effects during the pregnancy in which it occurs but results in an amplified immune response if further maternal exposure to the D antigen occurs during a subsequent pregnancy.
Ann of EM, ePub, Online 12/12/11
June 02, 2013
Review of 17 trials with a total of 1,998 patients demonstrated that compared to direct laryngoscopy, glidescope video-laryngoscopy is associated with improved glottic visualization, particularly in patients with potentialor simulated difficult airways.
Can J Anesth/J Can Anesth (2012) 59:41–52
June 01, 2013
When bedside pelvic ultrasonography does not demonstrate an intrauterine pregnancy, serum -hCG level is not helpful in differentiating intrauterine from ectopic pregnancy in symptomatic ED patients.
Ann Emerg Med. 2011;58:12-20
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