American Academy of Emergency Medicine

Fact of the Day - January 2015

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

January 31, 2015

For children in convulsive status epilepticus, lorazepam is not better than diazepam in terms of efficacy or safety

Chamberlain JM, Okada P, Holsti M, et al. Lorazepam vs diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA : the journal of the American Medical Association. Apr 23-30 2014;311(16):1652-1660.

January 30, 2015

Nebulized hypertonic saline for children with bronchiolitis in the ED leads to decreased admission rates, but not lower respiratory distress severity or length of hospital stay.

Wu S, Baker C, Lang ME, et al. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial. JAMA pediatrics. Jul 2014;168(7):657-663.

January 29, 2015

When placing central lines with the aid of ultrasound, the supraclavicular approach provides a clearer view of the subclavian vein. It is unclear if this correlates with improved success when placing these lines

Stachura MR, Socransky SJ, Wiss R, Betz M. A comparison of the supraclavicular and infraclavicular views for imaging the subclavian vein with ultrasound. The American journal of emergency medicine. Aug 2014;32(8):905-908.

January 27, 2015

The specificity of the D-dimer test can be increased without significantly decreasing sensitivity by applying an age-adjusted D-dimer cutoff value to rule out suspected venous thromboembolism in non-high-risk older patients.

Adams D, Wlch JL, Kline JA. Clinical utility of an age-adjusted D-dimer in the diagnosis of venous thromboembolism. Annals of Emergency Medicine (New York). 2014 September; 64 (3) : 232-34.

January 26, 2015

Regardless of presenting rhythm, administration of calcium during cardiopulmonary resuscitation has not been shown to improve survival.

Landry A, Foran M, Koyfman A. Does calcium administration during cardiopulmonary resuscitation improve survival for patients in cardiac arrest. Annals of Emergency Medicine (New  York). 2014 August; 64 (2) : 187 – 89.

January 25, 2015

An ED observation protocol for syncopal events reduces hospital admission rates, hospital length of stay, and reduces hospital costs with no change in rate of safety events.

Sun BC, et al. Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission. Annals of Emergency Medicine (New  York). 2014 August; 64 (2) : 167-75. 

January 24, 2015

Video laryngoscopy provides a better view of the glottic opening compared to direct laryngoscopy but does not improve the overall rates of intubation success. It does, however, decrease the time required for intubation in difficult airways.

Carlson JN, Brown CA. Does the use of video laryngoscopy improve intubation outcomes? Annals of Emergency Medicine (New York). 2014 August; 64 (2) : 165-66.

January 23, 2015

Clinicians should consider patient age, scalp hematoma location and size, and mechanism of injury in order to determine whether asymptomatic children under the age of 2 with isolated scalp hematomas should receive neuroimaging following a minor head trauma.

Dayan PS, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Annals of Emergency Medicine (New York). 2014 August; 64 (2) : 153 – 62.

January 22, 2015

The use of Ketamine on intracranial and cerebral perfusion pressure in critically ill patients does not appear to adversely affect patient outcomes.

Lindsay Cohen et al. Annals of Emergency Medicine. The Effect of Ketamine on Intracranial and Cerebral Perfusion Pressure and Health Outcomes: A Systematic Review. 2014 Jul 16.

January 21, 2015

Plain AP pelvic radiographs have a limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.

Marcia Y Kwok et al. Annals of Emergency Medicine. Sensitivity of Plain Pelvis Radiography in Children with Blunt Torso Trauma. 2014 Jul 29.

January 20, 2015

Visual needle cricothyroidotomy may be feasible and may lead to a decrease in procedure time and procedure-related complications compared to the conventional procedure.

Yanmei Feng et al. American Journal of Emergency Medicine. A new strategy for difficult airway management with visual needle cricothyroidotomy; a manikin study. 2014 Aug 15.

January 18, 2015

In type 2 diabetic patients with community acquired bloodstream infections, a substantial proportion of patients developed DKA. This condition was probably under recognized by clinicians and constituted an independent risk factor for short-term mortality.

Chia-Hung Yo et al. American Journal of Emergency Medicine. Prognostic determinants of community-acquired bloodstream infections in type 2 diabetic patients in ED. 2014 Aug 29

January 17, 2015

Acute angle closure glaucoma needs urgent opthalmologic consultation and treatment to prevent irreversible optic nerve damage. The common signs and symptoms are severe unilateral pain, redness, nausea, vomiting, blurry vision, and a mid-dilated pupil that reacts poorly to light.

Leibowitz HM. The red eye. N Engl J Med 2000; 343(5): 345.

January 16, 2015

The Ottawa Ankle Rules have been validated in children (sensitivity = 98.5%) and proven to be an effective way to determine if a child needs imaging after mid-foot or ankle injury.

Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB.  Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med 2009; 16(4): 277-87. 

January 15, 2015

Mycoplasma pneumoniae has historically been referred to as the likely cause of bullous myringitis. However, the most common bacteria to cause bullous myringitis are the typical acute otitis media organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis).

Mellick LB, Verma N. The Mycoplasma pneumoniae and bullous myringitis myth. Pediatr Emerg Care 2010; 26(12): 966-8.

January 13, 2015

Antipyretics do not prevent the recurrence of febrile seizures in children.

Rosenbloom E, et al.  Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis.  Eur J Paediatr Neurol 2013; 17(6): 585-8. 

January 12, 2015

All knee radiographs should be examined closely for bone avulsion fragments from the fibular head, femoral condyles, and intercondylar eminence, because these may indicate ligamentous injury. Widened joint spaces associated with a fracture of the opposite condyle also may indicate concomitant ligamentous injury.

Marx JA, Hockberger RS, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier/Saunders, 2014.

January 11, 2015

Carotid and vertebral dissections often are associated with trauma but may follow such mild events as turning the head sharply. Carotid and vertebral dissections also are seen more frequently in people with underlying pathology of the vessel wall, such as in fibromuscular dysplasia and connective tissue disorders. Alteration in the vessel intima can lead to vessel stenosis, occlusion, or embolism. The patient may report a minor preceding event such as spinal manipulation, yoga, working overhead, coughing, or vomiting.

Marx JA, Hockberger RS, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier/Saunders, 2014.

January 10, 2015

With a factitious disorder, the production of symptoms and signs is compulsive; the patient is unable to refrain from the behavior even when its risks are known. The behavior is voluntary only in the sense that it is deliberate and purposeful (intentional) but not in the sense that the acts can be fully controlled. The underlying motivation for producing these deceptions, securing the sick role, is primarily unconscious.

Marx JA, Hockberger RS, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier/Saunders, 2014.

January 09, 2015

In general, prophylactic antibiotics are not indicated for routine dog bite wounds, except those of the hand. The most recent randomized controlled trial to address this showed a control infection rate of 4.3% (2 of 46 patients, confidence interval [CI] 0-7%) with a prophylactic antibiotic infection rate of zero (0 of 48 patients). The difference was not statistically significant. A reasonable approach, therefore, would be to give prophylactic antibiotics to high-risk patients and to those with dog bite wounds of the hand or other high risk wounds.

Marx JA, Hockberger RS, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier/Saunders, 2014.

January 08, 2015

Any analysis of a urine sample must be performed immediately after collection. Urine specimens that are allowed to sit for longer than 2 hours become alkaline, with subsequent dissolution of the cellular elements and multiplication of bacteria, thus providing the clinician with markedly unreliable results.

Marx JA, Hockberger RS, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier/Saunders, 2014.

January 07, 2015

Early and adequate atropine administration in organophosphorus (OP) or insecticide poisoning improves outcome.

Konickx LA. Clin Toxicol (Phila). 2014 Jun;52(5):531-7.

January 06, 2015

Oral rehydration therapy is the cornerstone of management of dehydration in the acute setting.

Dekate, P. Indian J Pediatr. 2013 Mar;80(3):235-46

January 05, 2015

The pain of ureteral colic arises from sudden increases in ureteral smooth muscle tension caused by enhanced intraluminal pressure. Nonsteroidals (NSAIDs) are especially useful in patients with renal or ureteric colic.

Jones, A., Ramakrishnan, K. The Internet Journal of Emergency Medicine. 2004 Volume 2 (2).

January 04, 2015

New onset atrial fibrillation (AF) is atrial fibrillation identified for the first time by an electrocardiogram in an ambulatory setting.

Snow V, Weiss KB, LeFevre M, et al. Ann Intern Med 2003; (139):1009.

January 03, 2015

A potentially lethal complication of tumor lysis syndrome in the acute setting is supportive care, attention to metabolic disturbances and renal function.

Ikeda, A. Medscape. 2012; http://emedicine.medscape.com/article/282171-overview.

January 02, 2015

Plain films miss up to 30% of small bowel obstructions.

Chapter 3, "Abdominal and Gastrointestinal Disorders", Emergency Medicine: A Focused Review of the Core Curriculum, Amal Mattu, MD, Joseph P Martinez, MD, and Gregory Palmer, MD, PhD, page 78.

January 01, 2015

Hypertrophic cardiomyopathy is the second most common cause of sudden death in adolescents.

Chapter 2, "Cardiovascular Disorders", Emergency Medicine: A Focused Review of the Core Curriculum, James E Colletti, MD, and Jeffrey A. Tabas, MD, page 43.