Keywords: dysarthria, stroke (PubMed Search)
Depending on the location of infarct, stroke patients with dysarthria (a motor speech disorder) may exhibit the following signs and symptoms:
Category: Critical Care
Airway Pressure Release Ventilation (APRV)
Stawicki SP, Goyal M, Sarani B. High-frequency oscillatory ventilation and airway pressure release ventilation: A practical guide. Journal of Intensive Care Medicine 2009;24(4):215-29.
Keywords: Pertussis, Whooping Cough (PubMed Search)
Pertussis (Whooping Cough):
Nelson's Essentials of Pediatrics, 5th Edition
Keywords: Cushing Syndrome (PubMed Search)
The most common cause of Cushing syndrome is the use of exogenous glucocorticoids, and it is rarer to have a problem with the hypothalamic-pituitary-adrenal axis.
These patients can present with:
For the emergency department we need to be worried about those on chronic steroids that can not increase their native steroid production in a time of stress which will lead them to adrenal crisis.
Pearls for those with Cushing Syndrome:
Keywords: Menthol, camphor, vicks, seizure (PubMed Search)
Vicks VapoRub Toxicity
With the removal of OTC product indications for children under the age of 2 for cough and colds, more parents are turning to other agents such as Vicks VapoRub for the relief of cough and cold symptoms. Unfortunately these agents are also associated with toxicities and the potential exists for an increased number of poisonings. The primary components of these agents are:
Menthol is used to relieve symptoms of chest congestion. There is NO data to support efficacy, and paradoxically, studies have indicated increased airflow resistance with application. There is a case report of an 18 month old who developed respiratory distress after application. Symptoms associated with overdose, or inappropriate route (mucosal, oral) are:
Camphor in products with higher concentrations such as Campho-phenique can cause additional toxicity with effects:
Treatment for both is supportive.
"Vicks VapoRub Safety in Children" Pharmacists Letter: Detail Document 250306, March 2009
Keywords: pml, progressive multifocal leukoencephalopathy, HIV, AIDS, opportunistic infections, demyelinating diseases (PubMed Search)
Category: Critical Care
Antibiotic Dosing in the Critically Ill Septic Patient
Pea F, Viale P. Bench to bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter? Crit Care 2009;13:214.
New Antihypertensive agent coming our way...
Well, we have nitroprusside, labetalol, nicardipine, fenoldopam, etc. Say hello to a new drug that is "reported" to be a great drug for ED patients with severe hypertension (emergencies)....Clevipidine (Cleviprex).
Clevidipine is an ultrashort acting calcium channel blocker that has been found to be a powerful antihypertensive medication.
Unique properties of the drug:
Remains to be seen if this drug will play in a role in the treatment of our severely hypertensive patients....stay tuned...
Keywords: elderly, dehydration (PubMed Search)
Hypovolemia is very common in the ederly for two reasons:
1. The elderly have a decreased thirst response...in other words, it takes longer for them to develop thirst in the setting of dehydration.
2. The elderly have a decreased renal vasopressin response to hypovolemia.
From a treatment standpoint, one should always assume an elderly patient is hypovolemic. Hydration is incredibly important during resuscitation of the elderly patient.
Keywords: Monteggia's Fracture (PubMed Search)
Wheeless' Textbook of Orthopaedics http://www.wheelessonline.com/ortho/monteggias_fracture
Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med. 1995;149:36-39
Macpherson RI, Hill JG, Otherson HB, Tagge EP, Smith CD. Esophageal foreign bodies in children: diagnosis, treatment, and complications. AJR Am J Roentgenol. 1996;166:919-924
Keywords: lidocaine (PubMed Search)
To feed of off Dr. Liferidge's last pearl - a few more points relevant to your Emergency Department practice:
1) Hess GP, Walson PD: Seizures secondary to oral viscous lidocaine. Ann Emerg Med 1988; 17:725-272.
2) Rothstein P, Dornbusch J, Shaywitz B: Prolonged seizures associated with the use of viscous lidocaine. J Pediatr 1982; 101:461-463.
Keywords: lidocaine, lidocaine toxicity, seizure (PubMed Search)
Category: Critical Care
Internal Jugular CVC Placement and Posterior Wall Penetration
Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med 2009;37:2345-9.
Category: Airway Management
Keywords: Upper GI Bleed, Fistula (PubMed Search)
Aortoenteric Fistula (AEF)-Beware the Upper GI Bleed!
Important points about AEF:
Pearl: Suspect a aortoenteric fistula in any patient with a prior AAA repair who presents with an upper GI bleed (may also be lower GI bleed)
Keywords: mortality, acute coronary syndromes, prognosis (PubMed Search)
The elderly are at tremendous risk of death after MI, in no small part because we tend to undertreat them. The 30-day mortality rate after MI in patients < 65 is 3%.
In patients 65-74, the 30-day mortality is 10%.
In patients 75-84, the 30-day mortality is 20%.
In patients > 85, the 30-day mortality is 30%.
Be vigilant and be aggressive with elderly patients. Their early management has a tremendous bearing on their later outcomes.
Category: Obstetrics & Gynecology
Keywords: postpartum, headache (PubMed Search)
Haddad GG. Primary ciliary dyskinesia. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB SaundersCo; 2000:1327-1328
Keywords: ciguatera toxin, marine toxin (PubMed Search)
Keywords: dysphagia, stroke, dysarthria, gag reflex (PubMed Search)