Keywords: traumatic brian injury, TBI, respirations, cheyne-stokes, hyperventilation (PubMed Search)
Keywords: superior vena cava, svc syndrome (PubMed Search)
Superior Vana Cava Synrome....when to suspect
Two common causes of SVC syndrome include thrombus (secondary to CV catheters) and lung tumors/lymphoma
Consider this diagnosis in patients with a history of cancer and/or who have a central line in place and the complaint of facial swelling. Patients may not look swollen to you.
In addition, make sure to look at their necks and chest wall-presence of asymmetric, prominent veins should prompt consideration for this diagnosis.
A useful clinical tool is to look at the patient's driver's license (assuming they have one) and compare to their appearance on presentation.
Workup in most cases will involve a CT of the chest.
Clinical Oncology, 2007
Category: Critical Care
Keywords: bicarbonate, pH, COPD, mechanical ventilation (PubMed Search)
COPD and mechanical ventilation
Ward NS, Dushay KM. Clinical concise review: Mechanical ventilation of patients with chronic obstructive pulmonary disease. Crit Care Med 2008;36:1614-9.
Keywords: Mallet finger, Extensor Injury (PubMed Search)
Extensor Tendon Injuries [Mallet Finger]
Keywords: electrocardiography, ECG, STEMI, acute myocardial infarction, rescue PCI (PubMed Search)
According to the most recent (2007 Updated) ACC/AHA Guidelines for management of STEMI, the ECG is one of the most important tools to assess for successful reperfusion after thrombolytics. The treating physician should assess the ECG at 90 minutes after administration of lytics. Failure of the ST elevation to decrease by at least 50% in magnitude in the lead with the greatest initial amount of ST elevation is an indication of failed thrombolysis...regardless of whether or not the patient has persistent symptoms. In fact, the Guidelines specifically state that signs and symptoms are considered unreliable indicators of successful reperfusion.
Patients with ECG evidence of failed thrombolysis at 90 minutes should be referred for emergent PCI ("rescue PCI").
Keywords: Retropharyngeal Abscess, Neck Pain, Torticollis, Fever (PubMed Search)
Craig, FW and Schunk, JE. Retropharyngeal Abscess in Children: Clinical Presentation, Utility of Imaging, and Current Management. Pediatrics. 2003;111;1394-1398
Keywords: cyanide (PubMed Search)
Toxicology Trivia for $1000 - These are in fruits of the "rose" family and in some roots that contain cyanogenic glycosides and other cyanide containing compounds. It would actually take a fair amount of work to ingest enough to reach toxicity:
Keywords: orbital floor fracture, neuropathy (PubMed Search)
-- Enophthalmos (eye receded into the orbit) may occur when globe is
displaced posteriorly, often with prolapse of tissue into maxillary sinus.
-- Orbital dystopia (affected eye in a lower horizontal plane than the other) may
occur due to the pulling of entrapped muscle and orbital fat.
Category: Critical Care
Keywords: PEEP, acute lung injury, acute respiratory distress syndrome (PubMed Search)
Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)
Keywords: AV Fistula (PubMed Search)
Management of Ruptured AV Fistula
This pearl pertains to a case I had 2 weeks ago. A 65 yo male presented with a massively swollen left forearm in the region of his AV fistula. On ultrasound he had a 6 X 6 cm aneurysm. He was seen by vascular and transplant surgery and taken to the OR for repair.
So, the question came up, what would an emergency physician do if this bad boy actually ruptured? Well, obviously we would hold pressure. But what if that didn't work? Well, shouldn't the patient go to the OR? The answer is a resounding yes, but what if there is no surgeon around. There is not much literature on how to handle this devastating vascular catastrophe.
As a rule of thumb, if an AV Fistula ruptures (not leaks) and the patient is exsanguinating in front of you:
J Vasc Surg 2005
Keywords: Brugada syndrome, atrial fibrillation (PubMed Search)
Brugada syndrome, believed to be responsible for up to 4-5% of all episodes of cardiac arrest, has now been associated with atrial fibrillation as well (atrial fibrillation is the most common atrial dysrhythmia associated with Brugada syndrome). Patients with atrial fibrillation that have a full or incomplete right bundle branch block with ST segment elevation in leads V1-V2 should be referred to an electrophysiologist for evaluation of Brugada syndrome. The best treatment for these patients is still placement of an ICD.
Keywords: Posterior Interosseous Nerve, Compression, Radial Tunnel (PubMed Search)
Posterior Interosseous Nerve Compression Syndrome
As eluded to last week Posterior Interosseous Nerve (PIN) Compression Syndrome, a deep branch of the radial nerve, is felt to be radial tunnel syndrome with paralysis.
Keywords: Acute Otitis Media, Topical Lidocaine, Wait and See, Analagesia (PubMed Search)
Topical Lidocaine for Acute Otitis Media
Spiro, D. Tay, K. Wait-to-see prescription for the treatment of acute otitis media. JAMA 2006, 1235.
Bolt, P., Barnett, P., Babl, F., Sharwood, L. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008; 93: 40-44.
Bass. Sudden Sniffing Death. JAMA 1970.
Keywords: TIA, Stroke (PubMed Search)
Category: Critical Care
Keywords: propofol (PubMed Search)
Propofol Infusion Syndrome
Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia 2007;62:690-701.
Keywords: Hypertension (PubMed Search)
Side Effects of Hydrochlorothiazide
Consider the following when prescribing HCTZ from the emergency department:
The side effects of hydrochlorothiazide include hypokalemia,hypercalcemia, hypomagnesemia, metabolic alkalosis, hyponatremia, hyperuricemia (may worsen gout), hyperglycemia, hypercholesterolemia, hypertriglyceridemia.
Journal of Hypertension, 2006
Keywords: syncope, arrhythmia (PubMed Search)
Keywords: Radial Tunnel Syndrome (PubMed Search)
For those at the University of Maryland that got the chance to hear my lecture this week, you learned about Cubital tunnel syndrome [ulnar neuropathy], the second most common compressive neuropathy. Carpal Tunnel syndrome remains the number one compressive neuropathy, and this pearl, for the sake of completeness, will address Radial tunnel syndrome.
Radial Tunnel Syndrome
Stay tuned for next week for Posterior Interosseous Nerve syndrome.
Keywords: Burns, Parkland, Burn Percent, Burn Classification (PubMed Search)
Duffy BJ, McLaughlin PM, Eichelberger MR. Assessment, Triage, and Early Management of Burns in Children. Clinical Pediatric Emergency Medicine. 2006; 7:82-93.
Burn Service Manual, Children’s National Medical Center. Emergency, Trauma and Burn Services, Children’s National Medical Center, Washington, DC.