UMEM Educational Pearls

Category: Critical Care

Title: Utilization of the Mechanical Ventilator in Cardiac Arrest

Keywords: CPR, Cardiac Arrest (PubMed Search)

Posted: 11/15/2016 by Rory Spiegel, MD (Emailed: 3/23/2019)
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It is well documented that when left to our own respiratory devices we will consistently over-ventilate patients presenting in cardiac arrest (1). A simple and effective method of preventing these overzealous tendencies is the utilization of a ventilator in place of a BVM. The ventilator is not typically used during cardiac arrest resuscitation because the high peak-pressures generated when chest compressions are being performed cause the ventilator to terminate the breath prior to the delivery of the intended tidal volume. This can easily be overcome by turning the peak-pressure alarm to its maximum setting. A number of studies have demonstrated the feasibility of this technique, most recently a cohort in published in Resuscitation by Chalkias et al (2). The 2010 European Resuscitation Council guidelines recommend a volume control mode at 6-7 mL/kg and 10 breaths/minute (3).

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Category: Toxicology

Title: Opioid Prescription Drug Abuse - The Pattern of Abuse

Keywords: opioids, toxicology (PubMed Search)

Posted: 11/20/2014 by Fermin Barrueto, MD (Emailed: 3/23/2019) (Updated: 3/23/2019)
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The pattern of prescription drug abuse continues to center around semisynthetic opioids like oxycodone and hydrocodone. Federal regulations have now raised hydrocodone to a schedule II drug like oxycodone. Despite efforts, the slope for natural and semisynthetic opioids remains steep.  The ED measures of education, limit prescriptions for acute pain, minimize number of days/pills prescribed and utlize the prescription drug monitoring program are some basics that can assist you in better prescribing habits.

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Category: Critical Care

Title: Predicting peri-Intubation hypotension

Keywords: peri-Intubation, shock index (PubMed Search)

Posted: 2/7/2017 by Rory Spiegel, MD (Emailed: 3/23/2019)
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Identifying patients at risk of hypotension during intubation is not always straight forward. The prevalence of peri-intubation hypotension in the Emergency Department has been demonstrated to be approximately 20%.1 And while certain variables increase the likelihood of peri-intubation hypotension (ex. Shock index> 0.80), no single factor predicts it accurately enough to be used at the bedside.2 In the majority of patients undergoing intubation, clinicians should be prepared for peri-intubation hypotension with either vasopressor infusions or push dose pressors.

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Category: Toxicology

Title:

Keywords: vaping (PubMed Search)

Posted: 7/6/2018 by Kathy Prybys, DO (Emailed: 3/23/2019) (Updated: 3/23/2019)
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 Vaping. is the use of electronic device to heat a liuid to generate an aersol or vapor to inhale. The lqiud usually contains nicotine, propylene gylcol, gylcerine, and flavoring. E cigarettes are popular for various reasons simulate tobacco use, odorless, believed to be healthier than tobacco, circumvent no smoking laws, delivery system for cannabinoids. The JUUL, is a sleekly designed e-cigarette which resembles a a USB drive and is increasingly being used by youth and young adults.

 

Although e-cigarettes cause less health effects than tobacco, current evidence indicates that they are not without risk.


Category: Toxicology

Title: Hydrofluoric Acid Burns

Keywords: hydrofluoric acid, burn, chemical burn, HFA, calcium gluconate (PubMed Search)

Posted: 9/5/2010 by Dan Lemkin, MD (Emailed: 3/23/2019) (Updated: 10/2/2010)
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Hydrofluoric acid is a weak acid used primarily in industrial applications for glass etching and metal cleaning/plating. It is contained in home rust removers. Although technically a weak acid, it is very dangerous and burns can be subtle in appearance while having severe consequences.

Hydrofluoric acid burn

Wilkes G. Hydrofluoric Acid Burns. Jan 28, 2010. 
http://emedicine.medscape.com/article/773304-overview

  • 2 mechanisms that cause tissue damage*
    • corrosive burn from the free hydrogen ions
    • chemical burn from tissue penetration of the fluoride ions
  • Clinical features*
    • Cutaneous burns - absent findings to white-blue appearance
    • Pulmonary edema
    • Hypocalcemia, hyperkalemia, hypomagnesemia
  • Treatment*
    • Decontaminate by irrigation with copious amounts of water.
    • With any evidence of hypocalcemia, immediately administer 10% calcium gluconate IV.
    • Cutaneous burns:
      • Apply 2.5% calcium gluconate gel to the affected area. If the proprietary gel is not available, constitute by dissolving 10% calcium gluconate solution in 3 times the volume of a water-soluble lubricant (eg, KY gel). For burns to the fingers, retain gel in a latex glove.
      • If pain persists for more than 30 minutes after application of calcium gluconate gel, further treatment is required. Subcutaneous infiltration of calcium gluconate is recommended at a dose of 0.5 mL of a 5% solution per square centimeter of surface burn extending 0.5 cm beyond the margin of involved tissue (10% calcium gluconate solution can be irritating to the tissue).
        • Do not use the chloride salt because it is an irritant and may cause tissue damage.

*Extracted from emedicine article.

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Question

50 year-old male with cough and dyspnea. What's the diagnosis?

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Category: Vascular

Title: D-Dimer in Pregnancy

Keywords: D-Dimer, Pregnancy (PubMed Search)

Posted: 7/9/2008 by Rob Rogers, MD (Emailed: 3/23/2019) (Updated: 3/23/2019)
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D-Dimer levels are known to be elevated in pregnancy. But how high is too high and can this test be used in the workup of VTE in pregnant patients?

Recent literature indicates that D-dimer levels in each of the three trimesters are approximately 39% higher: 700, 1000, and 1400 ng/dL for each trimester (normal cutoff 500 ng/dL). So, figure out what trimester your patient is in and use the corresponding D-Dimer level for that trimester.

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Category: Pediatrics

Title: Visual Diagnosis Pediatrics: Case thanks to Ari Kestler MD (@KestlerMD) and Haney Mallemat MD (@CriticalCareNow)

Keywords: non-accidental trauma, clavicle fracture, neonate, pediatrics, abuse (PubMed Search)

Posted: 10/4/2014 by Ashley Strobel, MD (Emailed: 3/23/2019)
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Question

Q: What is wrong with this baby? And what Dx should you entertain?

Previously healthy 7d old presents after difficulty feeding, one episode of vomiting and now with intermittent apneic episodes.

 

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Attachments

Clavicle_Fracture.jpg (1,743 Kb)


Category: Orthopedics

Title: Fulcrum test

Posted: 10/1/2017 by Brian Corwell, MD (Emailed: 3/23/2019) (Updated: 3/23/2019)
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https://www.physio-pedia.com/Fulcrum_Test


Category: Orthopedics

Title: Morel-Lavall e lesion

Posted: 10/1/2017 by Brian Corwell, MD (Emailed: 3/23/2019) (Updated: 3/23/2019)
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126145/