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.
Keywords: prolonged QT, arrhythmia, adverse effect, antiarrhythmics, antibiotics, antipsychotics (PubMed Search)
Other factors that are associated with prolonged QT include: bradycardia, female sex, genetics, and electrolyte abnormalities.
Kannakeril PJ, Roden DM. Drug-Induced long QT and torsade de pointes: recent advances. Current opinions in cardiology. Jan 2007;22(1):39-43.
Horn JR, Hansten PD. Drug Interactions and QT Interval Prolongation. Pharmacy Times Dec 2004. pp66.
Keywords: antihypertensives, blood pressure, intracranial hemorrhage (PubMed Search)
Category: Critical Care
Keywords: intra-aortic balloon pump counterpulsation, cardiogenic shock (PubMed Search)
Intra-aortic balloon pump counterpulsation
Kim JT, Lee JR, Kim JK, et al. The carina as a useful radiographic landmark for positioning the intra-aortic balloon pump. Anesth & Analg 2007;105:735-8.
Keywords: Leukemia (PubMed Search)
Suspected Acute Leukemia in the ED
Key ED Interventions for patients with astronomically high WBC counts:
Keywords: internal cardioverter defibrillator, infection (PubMed Search)
Infections occur in up to 8-9% of ICD sites. Early infections usually occur within the first 2 months of placement and are associated with typical findings...redness, tenderness, systemic symptoms, etc. Late infections, however, are often associated with nothing more than JUST pain.
Lack of diagnosis of ICD site infections is associated with a mortality > 50%.
When infected, the entire ICD (including wires) must be replaced.
The most commor organisms associated with ICD infections are Staph and Strep. Treat them all with vancomycin.
Keywords: Turf Toe (PubMed Search)
Most commonly seen in atheletes who compete on artificial turf. Presents as pain over the 1st Metatarsalphalangeal (MTP) joint.
Keywords: Inuries, Falls, Poisoning, Drowning (PubMed Search)
Pediatric Accidental Non-Fatal Injuries
Karin A. Mack, Julie Gilchrist, Michael F. Ballesteros. Injuries Among Infants Treated in Emergency Departments in the United States, 2001—2004. Pediatrics; May 1 2008; 121 (5), 930-937.
Keywords: amanita, mushrooms, liver (PubMed Search)
How to recognize a truly toxic mushroom ingestion (remember one mushroom can be lethal!):
1) Onset of GI symptoms within 3 hours from time of ingestion: USUALLY NONTOXIC
- Control nausea and vomiting
- Look for toxidrome: hallucinations, muscarinic symptoms, lethargy
2) Onset of GI symptoms greater than 5 hrs is associated with more toxic mushrooms
- High degree of suspicion for a cyclopeptide mushroom (Amanita phylloides)
- Follow liver enzymes and consier referral to liver transplant center
Category: Critical Care
Keywords: glucose, critically ill (PubMed Search)
Bedside Glucometry in the Critically Ill
Desachy A, et al. Accuracy of Bedside Glucometry in Critically Ill Patients: Influence of Clinical Characteristics and Perfusion Index. Mayo Clin Proc 2008;83:400-5.
Keywords: hemorrhage (PubMed Search)
Hemorrhage Volume on Head CT
Ever wanted to speak the same language as our neurosurgical colleagues? Ever wonder what they are doing, calculating, or thinking about as they look at the head CT of the large intracranial hemorrhage?
Most of the neurosurgeons want to know basic information about patients with head bleeds. One thing they always calculate is the hemorrhage volume...i.e. how many mLs of blood are in the bleed? This can be easily done in the ED by using the following formula: called the ABC formula.
A X B X C/2 X 0.6= mL of blood
A= largest width of the bleed (in cm)
B=largest width perpindicular to A
C=number of cuts you see blood on
So, if A=2cm, B=2cm and the bleed is seen on 3 cuts.....
2 X 2 X 3/2 X 0.6=3.6 mL of blood (not very much in the opinion of a neurosurgeon)
Most of the big bleeds that neurosurgeons drain or take to the OR are 50 cc or so. So, when you call a neurosurgeon and tell them that the patient has 60 mLs of blood, you will definitely get their attention.
Keywords: internal cardioverter-defibrillator, shock, defibrillation (PubMed Search)
Patients with ICDs presenting to the ED reporting that their ICD fired once do not need mandatory ICD interrogation, admission or an extensive ED workup purely based on the single shock. A workup should be initiated purely based on any other associated symptoms...chest pain, dyspnea, etc. If the patient was doing well and had no other symptoms prior to the shock, the patient should simply have close follow up with cardiology.
Patients presenting after multiple shocks, on the other hand, do need a workup and emergent ICD interrogation (most of these cases also are later deemed inappropriate shocks).
Keywords: Achilles Tendon Rupture (PubMed Search)
Achilles Tendon Rupture
This addition was sent in my Dr. Andrew Milstein:
Thanks for the Orthopedics update. A few pearls for Achilles Tendon Rupture --> often these patients may present like a typical ankle sprain patient and are placed in a hallway chair. You can't do an adequate Thompson Test while someone is sitting in a chair. If you're concerned, lay them down on a stretcher to do the test.
Keywords: Acute Chest Syndrome, Sickle Cell Disease, Fever, Chest Pain (PubMed Search)
Acute Chest Syndrome
NHLBI. Acute chest syndrome and other pulmonary complications. Management of Sickle Cell Disease. June 2003; 25 – 29. http://www.nhlbi.nih.gov/health/prof/blood/sickle/index.htm.
Kathleen Ryan, RN, MPH, Anju Chawla, MD and Matthew Heeney, MD. Management of Acute Chest Syndrome in Sickle Cell Disease. New England Pediatric Sickle Cell Consortium. 2005.
Keywords: dialysis, lithium salicylate (PubMed Search)
Keywords: intracranial hemorrhage, ich, intracranial hemorrhage expansion (PubMed Search)
PEA Arrest...Look for AAA rupture and Cardiac Tamponade
If a patient presents in cardiac arrest (particularly PEA), consider the following diagnoses in addition to the causes commonly taught in ACLS:
A 2004 study in Resuscitation by Meron et al. showed the following:
Take home point for the emergency physician:
Meron, et al. Resuscitation 2004
Category: Critical Care
Keywords: vasopressin, septic shock (PubMed Search)
Vasopressin for Sepsis