Keywords: cerebral aneurysm, SAH, intracranial bleed (PubMed Search)
Category: Critical Care
Keywords: PRVC, pressure control, volume control, ventilator-induced lung injury (PubMed Search)
Pressure Regulated Volume Control (PRVC)
Keywords: LMWH, PE, Pulmonary Embolism (PubMed Search)
Currently Approved LMWHs for the Treatment of Acute PE:
Make sure to monitor platelet counts regardless of agent chosen.
Konstantinides. Acute pulmonary embolism revisited. Heart. June 2008
Keywords: blunt cardiac trauma, cardiac contusion, myocardial contusion (PubMed Search)
"The most common EKG abnormalities are non-specific ST-T wave changes, followed by RBBB. A normal EKG does not exclude the possibility of cardiac injury, although some investigators report a negative predictive value of up to 80-90%."
[El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med 2008;35:127-133.]
Keywords: Urinary Catheter, Foley, Coude (PubMed Search)
Placing a foley catheter in a patient with BPH or acute urinary retention can be very difficult at times. Here are some tips to increase your chance of a successful placement.
If all else fails, a suprapubic catheter may need to be placed. For a great review on evaluation and treatment please see Drs. Vilke, Ufberg, Harrigan, and Chan's article in the August edition of Journal of Emergnecy Medicine entitled Evaluation and treatment of acute urinary retention.
Vilke GM, Ufberg JW, Harrigan RA, Chan TC. Evaluation and treatment of acute urinary retention. J Emerg Med. 2008 Aug;35(2):193-8.
Keywords: drug interactions, disulfiram, bactrim, tinidazole, metronidazole (PubMed Search)
Other common medications that produce this reaction:
1. Sulfonylureas: chlorpropamide, tolbutamide, glyburide
2. Cardiovascular medications: Isosorbide dinitrate, nitroglycerin
Weathermon R, Crabb DW. Alcohol and Medication Interactions. Alcohol Research and Health. 1999 (23);1:40-54.
Keywords: cerebral aneurysms, aneurysm, ACOM, PCOM, SAH (PubMed Search)
--- junction of the anterior communicating artery (ACOM) with the anterior cerebral artery (ACA)
--- junction of the posterior communicating artery (PCOM) with the internal carotid artery (ICA)
--- bifurcation of the middle cerebral artery (MCA)
Singer, et al. "Unruptured Intracranial Aneurysms." November 2007. UptoDate online 16.2.
Category: Critical Care
Keywords: post-intubation hypoxia, pneumothorax, mechanical ventilation (PubMed Search)
Post-intubation deterioration? Remember DOPE
Category: Infectious Disease
Keywords: necrotizing fasciitis (PubMed Search)
Necrotizing Fasciitis Pearl
A few things to remember about treating necrotizing soft tissue infections:
So, when shot-gunning the antibiotics in a patient with a really bad soft tissue infection (not the run of the mill cellulitis) consider adding Clindamycin to the regimen.
Infectious Disease Society of America, 2006
Keywords: stroke, intracranial, electrocardiography (PubMed Search)
Hemorrhagic and ischemic strokes are well-known to produce ECG changes that resemble cardiac ischemia. Large T-wave inversions are the most classic findings, but ST changes, prolonged QT interval, tachydysrhythmias, bradydysrhythmias, and AV blocks have also been described.
The exact cause of these changes is uncertain. One theory is that the strokes can produce catecholamine surges which cause the changes; another theory is that intracranial events produce a vagal response that causes ECG changes. Regardless of the reason, one should always keep stroke in the differential diagnosis for patients with ischemic-appearing ECG changes, especially when the patient has an altered mental status or neurologic deficit.
Keywords: Tessaly, Meniscal, Tear, Knee Exam (PubMed Search)
When examining a knee for a meniscal injury the commonly described tests are the McMurray Test and Apley Test. However, these tests have sensitivities of 48-68% and 41% respectfully, and specificities of 86-94% and 86-93% respectfully. Depending on whether you are looking at the medical or lateral meniscus.
The Tessaly Test that was first described in 2005 can be performed with knee in either 5 or 20 degrees of flexion and has a senstivity of 89-92% and specificity of 96-97% when performed in 20 degrees flexion. The test also tends to be easier to perform.
To perform the test:
Essentially you and your patient will look like you are doing the twist as they rotate their knee with you holding their hands.
The Journal of Bone and Joint Surgery (American). 2005;87:955-962.
Keywords: Sever's Disease (PubMed Search)
Keywords: tramadol, Ultram, seizure, seizure threshold (PubMed Search)
-- seizure disorder
-- alcohol withdrawal
-- drug withdrawal
-- CNS infections
-- metabolic disorder
-- head trauma
Category: Critical Care
Keywords: acute lung injury, alveolar overdistention, plateau pressure (PubMed Search)
The Importance of Plateau Pressure
DeGiorgi A, White M. Ventilator management: maximizing outcomes in caring fo asthma, COPD, and pulmonary edema. Emergency Medicine Practice 2008;10(8):1-23.
Keywords: D-Dimer (PubMed Search)
Causes of an Elevated D-Dimer
Don't forget the multiple causes of an elevated d-dimer:
**See attached PDF-Differential Diagnosis of Elevated D-Dimer
Journal of Thrombosis and Hemostasis, 2008
Keywords: electrocardiography (PubMed Search)
There are many causes of rightward axis on electrocardiography: RVH, COPD, acute (e.g. PE) or chronic (e.g. COPD, cor pulmonale) pulmonary hyptertension, sodium channel blocking drug toxicity (e.g. TCAs), ventricular tachycardia, hyperkalemia, dextrocardia, left posterior fascicular block, prior lateral MI, and of course misplaced leads.
In emergency medicine, however, the causes of acute/NEW rightward axis constitutes a smaller list. Perhaps the two most important causes of acute/new rightward axis in emergency medicine that should be remembered are PE and sodium channel blocker toxicity. In both of these conditions, the rightward axis may be the only obvious finding on the ECG.
The takeaway point is this: when you see new righward axis (compared to an old ECG) and you see nothing else "jumping out" at you, consider PE and consider sodium channel blocker toxicity.
Keywords: Femoral Vein, Access, Cannulation (PubMed Search)
Most people are now using Ultrasound to aid in cannulation of the femoral and internal jugular veins, but if you find yourself without the ultrasound machine you can increase your chance of successful cannulation of the femoral vein by positioning the leg properly.
Werner et al looked at the common femoral veins of 25 healthy volunteers and noted that the femoral vein was accessable more often when the hip was abducted and external rotated. This simple position change increased the mean diameter of the vein, and prevented the vein from being directly posterior to the artery.
Werner SL, Jones RA, Emerman CL. Effect of hip abduction and external rotation on femoral vein exposure for possible cannulation. J Emerg Med. 2008 Jul;35(1):73-5.
Keywords: Pyloric Stenosis (PubMed Search)
Keywords: mercury, poisoning (PubMed Search)
Keywords: neuropathy, knee injury, sural nerve, peroneal nerve, tibial nerve (PubMed Search)
-- IN SUMMARY:
*** Speaking of such deficits by naming the affected nerve distribution is particularly helpful when consulting orthopedists, neurologists, etc.