Category: Pediatrics
Keywords: Pediatric Burns, Fire, Injury, Burn Injuries, Sage Diagram, TBSA (PubMed Search)
Posted: 6/11/2010 by Adam Friedlander, MD
(Updated: 7/16/2024)
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Current American Burn Association guidelines state that any child with a greater than 10% total body surface area (TBSA) burn should be admitted to a center capable of caring for pediatric burns, rather than being discharged after wound management. However, physician use of TBSA% estimation techniques is variable. An excellent free tool for estimating TBSA is available online, allows for automatic weight based calculation, and allows printing of your diagram. The diagram is available at http://www.sagediagram.com/. More to come...
Category: Toxicology
Keywords: physostigmine, anticholinergic (PubMed Search)
Posted: 6/10/2010 by Bryan Hayes, PharmD
(Updated: 7/16/2024)
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Physostigmine has been used extensively in the fields of anesthesiology and emergency medicine. The only use of physostigmine with sound scientific support is for the management of patients with an anticholinergic syndrome, particularly those without cardiovascular compromise who have an agitated delirium. In this population, physostigmine has an excellent risk-to-benefit profile.
Category: Neurology
Keywords: lumbar puncture, LP, spinal tap (PubMed Search)
Posted: 6/9/2010 by Aisha Liferidge, MD
(Updated: 7/16/2024)
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Once you've punctured the spinal canal space during lumbar puncture, the following tips can be used to improve the rate of cerebrospinal fluid (CSF) flow, should it be suboptimal:
Category: Critical Care
Posted: 6/8/2010 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Platelet Transfusions in the Critically Ill
Netzer G, Hess JR, Shanholtz C. Use of blood products in the intensive care unit: Concepts and controversies. Contemporary Critical Care June 2010;8(1):1-12.
Category: Vascular
Keywords: Pulmonary Embolism (PubMed Search)
Posted: 6/7/2010 by Rob Rogers, MD
(Updated: 7/16/2024)
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Thrombolytic Therapy for Pulmonary Embolism
Current, FDA-approved thrombolytic therapy for PE:
Category: Geriatrics
Keywords: geriatrics, elderly, appendicitis (PubMed Search)
Posted: 6/7/2010 by Amal Mattu, MD
(Updated: 7/16/2024)
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Up to 25% of elderly patients with appendicitis are initially sent home from the ED, an indication of the high misdiagnosis rate for appendicitis in the elderly population. Why are elderly patients so often misdiagnosed when they have appendicitis? The answer is simple....they present very atypically.
Expect the atypical in elderly patients!
Category: Orthopedics
Keywords: Wound Care, Antiseptics (PubMed Search)
Posted: 6/5/2010 by Michael Bond, MD
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Wound Care:
Patients and many providers want to irrigate or wash a wound with an antiseptic solution in order to decrease the risk of infection. Most studies have shown that irrigation whether with tap water or sterile water is effective enough in reducing bacterial counts in a wound so does adding an antiseptic solution offer any additional benefit.
It turns out that hydrogen peroxide, and iodine based solutions can actually hinder wound healing as they causes delays in the migration and proliferation of fibroblasts at concentrations that are not even bactericidal. Chlorhexidine, and silver containing antiseptics [i.e.: silver sulfadiazine and silver nitrate] are bactericidal at concentrations that do not affect fibroblasts.
So in the end, if you feel the need to use an antiseptic, use chlorhexidine or a silver containing antiseptic. The use of hydrogen peroxide and iodine based solutions should be abandoned as they are not even bactericidal at concentrations that have profound affects on the fibroblasts.
Thomas, GS. Mechanisms of Delayed Wound Healing by Commonly Used Antiseptics. J Trauma 2009; 66:82-91
Category: Toxicology
Keywords: pediatrics, toxicology, antidepressant, antimalarial, antipsychotic, calcium channel, aspirin (PubMed Search)
Posted: 6/4/2010 by Ellen Lemkin, MD, PharmD
(Updated: 7/16/2024)
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There are a several classes of medications that can kill a toddler with a single dose. Toddlers are particularly susceptible due to their low weights and propensity to place everything in their mouths.
1. Calcium channel blockers
2. Camphor-containing rubs
3. Opioids/opiates
4. Oil of wintergreen/ aspirin
5. Cyclic antidepressants
6. Topical blood pressure patches (clonidine)
7. Eye drops and nasal sprays (oxymetazoline)
8. Sulfonylureas
9. Antimalarial drugs (cloroquine)
1. Morris-Kukowski, C. England AG. Toxicity, Deadly in a Single Dose. Emedicine, Pediatrics.
Category: Neurology
Keywords: optic neuritis, multiple sclerosis, blindness, visual abnormality (PubMed Search)
Posted: 6/2/2010 by Aisha Liferidge, MD
(Updated: 7/16/2024)
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Category: Critical Care
Posted: 6/1/2010 by Evadne Marcolini, MD
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Marino P. The ICU Book. 3rd ed. Lippincott
Category: Geriatrics
Keywords: fever, elderly, geriatrics (PubMed Search)
Posted: 5/30/2010 by Amal Mattu, MD
(Updated: 7/16/2024)
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Fever is less common in infectious states in the elderly than in young patients. However, in contrast to younger patients, when an elderly patient does have a fever it is much more likely to be associated with a serious bacterial infection. It has been estimated that the source of fever in elderly ED patients is viral in only 5% of cases.
[from Hals G. Common diagnoses become difficult diagnoses when geriatric patients visit the emergency department, part I. Emergency Medicine Reports 2010;31(9):101-110.]
Category: Orthopedics
Keywords: Septic Arthritis (PubMed Search)
Posted: 5/29/2010 by Michael Bond, MD
(Updated: 7/16/2024)
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Septic Arthritis versus Arthritis:
Though CRP and ESR levels are significantly higher in patients that have septic arthritis, a 1998 study showed that there is extensive overlap between patients with septic arthritis crystal assoicated arthritis that both CRP and ESR have low sensitivity, specificity and predictive values. Peripherial WBC counts did not differ between the two disease processes..
The morale of the story: If you are suspecting septic arthritis you need to perform an arthorcentesis to analysis the synovial fluid. Systemic biomarkers can not support one diagnosis over the other.
Soderquist B, Jones I, Fredlund H, Vikerfors T: Bacterial or crystal-associated arthritis? Discriminating ability of serum inflammatory markers. Scand J Infect Dis 1998; 30: 591-596.
Category: Airway Management
Posted: 5/27/2010 by Rose Chasm, MD
(Updated: 7/16/2024)
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some absolutes or almost always cases include the following:
MedStudy Pediatrics Board Review Core Curriculum, 1st ed.
Category: Toxicology
Keywords: scombroid, seafood (PubMed Search)
Posted: 5/27/2010 by Fermin Barrueto, MD
(Updated: 7/16/2024)
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Scombroid is caused by ingestion of preformed histamine on skin of fish.
Category: Neurology
Keywords: stroke (PubMed Search)
Posted: 5/26/2010 by Aisha Liferidge, MD
(Updated: 7/16/2024)
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Category: Critical Care
Posted: 5/25/2010 by Mike Winters, MBA, MD
(Updated: 7/16/2024)
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Postcardiac Arrest Syndrome: Controlled Reoxygenation
Nolan JP, Soar J. Postresuscitation care: entering a new era. Curr Opin Crit Care 2010;16:216-22.
Category: Vascular
Keywords: Pulmonary Embolism (PubMed Search)
Posted: 5/24/2010 by Rob Rogers, MD
(Updated: 7/16/2024)
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Massive Pulmonary Embolism and Response to Fluids and Mechanical Ventilation
Massive pulmonary embolism leads to acute pulmonary hypertension and right ventricular overload. This leads to release of troponin and a "bowing" of the interventricular septum on echocardiography. Deviation of the septum then leads to a decrease in left-sided cardiac output.
A few interesting clinical pearls:
Category: Geriatrics
Keywords: fever, elderly, geriatric (PubMed Search)
Posted: 5/23/2010 by Amal Mattu, MD
(Updated: 7/16/2024)
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Elderly patients have slightly lower body temperatures than younger adults, and as a result it has been suggested that "fever" be defined as anything > 99 degrees F. One study found that by lowering the definition to this number improved the sensitivity and specificity to 83% and 89%, respectively.
from Hals G. Common diagnoses become difficult diagnoses when geriatric patients visit the emergency department, part I. Emergency Medicine Reports 2010;31(9):101-110.
study referred to: Castle SC, et al. Fever response in elderly nursing home residents: are the older truly colder? J Am Geriatric Soc 1991;39:853-857.
Category: Orthopedics
Keywords: Osteomyelitis (PubMed Search)
Posted: 5/22/2010 by Michael Bond, MD
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Osteomyelitis:
King RW, Johnson D: Osteomyelitis. In: eMedicine. WebMd; 2009.
Category: Pediatrics
Keywords: Pediatrics, Hyperpronation, Radial Head Subluxation, Nursemaid (PubMed Search)
Posted: 5/21/2010 by Reginald Brown, MD
(Updated: 5/22/2010)
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Hyperpronation: This reduction technique for a nursemaid's elbow (radial head subluxation) has been found to have better first attempt success than classic supination/flexion technique. (Pediatrics July '98). Support the elbow with a finger on the radial head, and forcefully hyperpronate.
1005212340_Hyperpronation_technique.jpg (54 Kb)