Keywords: Laceration, Dermabond, cyanocrylate (PubMed Search)
Cyanocrylate Tissue Adhesive is an excellent product to use when repairing linear lacerations.
A few things to remember:
The wound needs to be irrigated as you would any other wound prior to closure.
Gravity works. Consider where the product may drip to before you apply it (Eyes, Ears, Nose, etc).
Use Surgi-Lube (or other petroleum product) to create a barrier to limit the flow of the cyanocrylate.
For long lacerations, you may use steri-strips to help approximate edges before applying the tissue adhesive.
What to do if the glue gets out of control and drips onto the eyelids... may also apply to Krazy-Glue:
Use copious irrigation and then Mineral Oil (not acetone or alcohol - which won't go well in the eyes).
Often there will be an associated corneal abrasion... treat it as other corneal abrasion.
Keywords: hyperkalemia, medications (PubMed Search)
Keywords: DHE, dihydroergotamine, migraine headache, headache, cluster headache (PubMed Search)
Category: Critical Care
Keywords: radial arterial line (PubMed Search)
Invasive Arterial Pressure Monitoring - Complications
In critically ill patients with hemodynamic instability we often place arterial catheters to continuously monitor mean arterial pressure. Since we frequently use the radial artery for cannulation, it is important to know the complications associated with these catheters. Scheer et al performed, perhaps, the largest review of complications of peripheral arterial catheters. The results:
Pearl: Although permanent ischemic damage is rare, when placing a radial artery catheter use the non-dominant hand.
Scheer BV, Perel A, Pfeiffer UJ. Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002;6:198-204.
Keywords: Fenoldopam, Hypertension (PubMed Search)
Intravenous Fenoldopam has been shown in recent years to be a very effective antihypertensive medication. Studies have compared it to Nitroprusside (Nipride), the older generation "gold standard" antihypertensive, and have found to be just as effective.
Journal of Hypertension 2007
Keywords: congestive heart failure, CHF, pulmonary edema (PubMed Search)
Recent literature (Collins, et al, Ann Emerg Med, Jan 2008; and Cotter, et al, Am Heart J, Jan 2008) confirms something that we've been talking about for YEARS....more than 50% of patients presenting with acute cardiogenic pulmonary edema are not fluid overloaded, but rather have fluid mis-distributed into the lungs. Management should focus on fluid re-distribution rather than diuresis. Use of diuretics in these patients is associated with worsening renal function, which is a significant predictor of in-hospital mortality.
The best patients to use diuretics on are patients with slow progression of dyspnea, lower extremity edema, and weight gain over days-weeks. In the absence of a history of this slow progression, don't go crazy with the diuretics!
Category: Obstetrics & Gynecology
Keywords: Migraines, Pregnancy (PubMed Search)
Migraines and Pregnancy
Keywords: Back Pain, Leukemia, Lymphoma, Neuroblastoma (PubMed Search)
Pediatric Back Pain
Keywords: transient neurological attack, transient ischemic attack, TNA, TIA, stroke (PubMed Search)
Bos, et al. "Incidence and Prognosis of Transient Neurologcial Attacks, " JAMA, pgs. 2877-85. Dec. 26, 2007.
Johnston. "Transient Neurological Attack: A Useful Concept?," JAMA, pgs. 2912-13. Dec. 26, 2007
Category: Critical Care
Keywords: pulse oximetry (PubMed Search)
Pitfalls in pulse oximetry in the critically ill
Keywords: Pulmonary, Pulmonary Embolism (PubMed Search)
Pulmonary CTA Sensitivity and PIOPED II
The publication of PIOPED II has led some to doubt the sensitivity of pulmonary CTA for pulmonary embolism. This study reported an overall sensitivity of 83% which could be increased to nearly 90% with the addition of CTV (CT Venography). 83% is a horrible sensitivity. So, why should you care?
Keywords: NSAIDs, aspirin, acute coronary syndrome (PubMed Search)
Aspirin is the only NSAID that should be used in the acute treatment and also the in-hospital management of patients with STEMI or NSTEMI/unstable angina, even if the patient is chronically managed on other NSAIDs. The use of any of the non-ASA NSAIDS, both nonselective as well as COX-2 selective agents, in these patients is associated with increased risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture. Their use should be discontinued immediately at the time of admission.
Keywords: Malpractice, Sued, Deposition (PubMed Search)
So you are getting sued. Here are some tips to handle your Deposition:
Courtesy of Larry Weiss, MD, JD
Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice.The speaker provides this information only for Continuing Medical Education purposes.
Keywords: Ketamine, RSI, TBI (PubMed Search)
Ketamine and RSI for pts p TBI
Keywords: encephalopathy, neurological, mental status abnormality (PubMed Search)
Category: Critical Care
Keywords: mean arterial pressure (PubMed Search)
Mean Arterial Pressure
Keywords: PE, Pulmonary Embolism (PubMed Search)
Optimal pulmonary artery opacification for detecting pulmonary embolism-how good was the CT you ordered?
The PE literature is pretty clear about one thing: a CT with well-timed opacification of the pulmonary arteries is very sensitive for detecting pulmonary embolism. This means that there needs to be enough contrast in the central pulmonary arteries to be able to detect clot. So how can you be really sure the PE Protocol CT you ordered is adequate? Have you really ruled out PE?
What does this mean for the emergency physician?
Some predict that in the future WE (the emergency physician) may in fact be held accountable for knowing whether or not a CTPA (CT Pulmonary Angiography) is optimal or not.
(1) Kline-Carolinas Medical Center (2) Journal of Thrombosis and Hemostasis 2007 (3) AJR 2006,2007
Keywords: atrial fibrillation, ST-segment depression (PubMed Search)
Transient ST-segment depression during rapid atrial fibrillation is of uncertain clinical significance (much as is true for ST segment depression in SVTs). A recent study indicates that ST-segment depression in rapid AFib is not consistently associated with positive stress testing or occlusions on cardiac catheterization.
On the other hand, if the ST-segment depression persists after the rate is controlled, then there should be greater concern.
[Androoulakis A. J Am Coll Cardiol 2007;50:1909-1911.]
Category: Infectious Disease
Keywords: Ludwig, Angina (PubMed Search)
Ludwig’s angina is most commonly a polymicrobial disease of mixed aerobic / anaerobic bacterial origin. Dental disease is the most common cause of Ludwig’s angina.
Diagnosis is usually made after obtaining a CT scan of the Neck and upper chest.
Once the diagnosis is made, treatment should consist of broad spectrum antibiotics and surgical evaluation by ENT or Oral Surgery for possible I&D. Aggressive management of the patient’s airway is a must, and the patient should be intubated early in the course of the illness if there is any sign of airway compromise. Nasal intubation may be preferred by ENT/Oral Surgery.
Typical Antibiotics include a Penicillin with clindamycin or metronidazole.
Ludwig’s Angina Trivia:
Keywords: ITP, Leukemia, Steroids, IVIG, Anti-Rh(d), Bone Marrow Aspiration (PubMed Search)
Pediatric ITP – Bone Marrow Aspiration