American Academy of Emergency Medicine

Fact of the Day - February 2016

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

February 29, 2016

Young adult methamphetamine users may be at a 3.7-fold increased risk for early onset cardiomyopathy compared to non-users. Further, methamphetamine has been determined to be an independent risk factor for cardiomyopathy.

Yeo K, Wijetunga M, Ito H, et al. The association of methamphetamine use and cardiomyopathy in young patients. Am J Med. 2007;120(2):165-71. PMID: 17275458

February 28, 2016

If healthy and >1 month old, oral antibiotics are as effective as a combination of IV and oral antibiotics in treating pyelonephritis for 10 to 14 days.

Cruz C, Spina L. Are oral antibiotics as effective as a combination of IV and oral antibiotics for kidney infections in children? 2016; 67 (1); 30-31. doi.org/10.1016/j.annemergmed.2015.06.026

February 27, 2016

If the INR is between 5 and 9 and the patient does not have clinically significant bleeding, warfarin is held temporarily (eg, one or two doses). A randomized trial found no reduction in bleeding from low-dose oral vitamin K in patients with an INR 4.5 to 10.0 and the 2012 American College of Chest Physicians suggests not using vitamin K in this setting.

Hull, R. et al. Management of warfarin-associated bleeding or supratherapeutic INR. Uptodate.com Nov 13, 2015

February 26, 2016

Zika virus is a flavivirus transmitted by the Aedes mosquito. It may be initially asymptomatic with a 3-12 day incubation period, followed by a nonspecific febrile illness with possible rash, joint pain, or conjunctivitis. There have been cases of Guillain-Barre syndrome reported in patients following suspected Zika virus infection. The Pan American Health Organization (PAHO) issued an epidemiological alert on 12/1/15 warning of a suspected link between Zika and neurological syndrome or congenital malformation, but it noted that final proof is lacking.

Dyer Owen. Zika virus spreads across Americas as concerns mount over birth defects BMJ 2015; 351 :h6983 Petersen EE, Staples JE, Meaney- Delman, D, et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak - United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30-33. DOI:http://dx.doi.org/10.15585/mmwr.mm6502e1http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm

February 25, 2016

The HEART score provides the clinician with a quick and reliable predictor of outcome. The Backus study included 2440 patients. The data was gathered prospectively. TIMI and GRACE scores were also obtained on patients and compared head-to-head to the HEART score. They found that the HEART score outperformed the TIMI and GRACE scores.

Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. doi: 10.1016/j.ijcard.2013.01.255. Epub 2013 Mar 7

February 24, 2016

Rapid endotracheal intubation is the treatment for respiratory distress due to congenital diaphragmatic hernia.

Tintinalli, J. E., & Stapczynski, J. S. 14 Resuscitation of Neonates. Tintinalli's emergency medicine: A comprehensive study guide (8th ed.). New York: McGraw-Hill. 2011.

February 23, 2016

4 Factor PCC is not associated with an overall increased risk of thromboembolic events.

Milling TJ Jr., Refaai MA, Goldstein JN, et al. Thromboembolic events after vitamin K antagonist reversal with 4-factor prothrombin complex concentrate: exploratory analyses of two randomized, plasma-controlled studies. 2016; 67 (1); 96-105. doi:10.1016/j.annemergmed.2015.04.036.

February 22, 2016

Morphine increased the risk of death in patients with acute coronary syndrome in one retrospective study.

Meine TJ, Roe MT, Chen AY, et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J 2005; 149:1043.

February 21, 2016

PE is associated with increased risk of cardiovascular disease and atrial fibrillation.

Hald EM, Enga KF, Løchen ML, et al. Venous thromboembolism increases the risk of atrial fibrillation: the Tromso study. J Am Heart Assoc 2014; 3:e000483.

February 20, 2016

Migraine is a known risk factor for hypertensive disorders during pregnancy.

Facchinetti F, Allais G, Nappi RE, et al. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia 2009; 29:286.

February 19, 2016

There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion.

Puls, H. A., Cabrera, D., Murad, M. H., et al. Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis. The Journal of Emergency Medicine. 2015.

February 18, 2016

IV fluids may worsen outcomes in patients with PE with RV dysfunction.

Ghignone M, Girling L, Prewitt RM. Volume expansion versus norepinephrine in treatment of a low cardiac output complicating an acute increase in right ventricular afterload in dogs. Anesthesiology 1984; 60:132.

February 17, 2016

Melanoma frequently metastasizes to the small intestine and can cause complications such as obstruction or perforation, but it is most commonly found postmortem on autopsy.

Lens M, Bataille V, Krivokapic Z. Melanoma of the small intestine. Lancet Oncology. 2009; 10:516-521.

February 16, 2016

Mobile vitreous opacity seen on ultrasound in the vitreous chamber is relatively common and may not be pathologic, even if unilateral and occurring at a relatively young age.

Budhram, G., Cronsell, J., Schroeder, M., et al. Mobile vitreous opacities on ocular ultrasonography are not always pathologic: a cross-sectional survey in an asymptomatic population. The American Journal of Emergency Medicine. 2015:33(12)1808-1813.

February 15, 2016

Tamsulosin was found to be effective in passage of distal ureteral stones for 5-10mm stones. It showed no overall benefit for stones less than or equal to 10mm.

Furyk JS, Chu K, Banks C, et al. Distal Ureteric Stones and Tamsulosin: A double-blind placebo controlled, randomized, multicenter trial. Annals of Emergency Medicine. 2016; 67 (1);86-95. doi:10.1016/j.annemergmed.2015.06.001.