Category: Obstetrics & Gynecology
Keywords: Migraines, Pregnancy (PubMed Search)
Posted: 1/27/2008 by Michael Bond, MD
(Updated: 2/19/2025)
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Migraines and Pregnancy
Category: Pediatrics
Keywords: Back Pain, Leukemia, Lymphoma, Neuroblastoma (PubMed Search)
Posted: 1/24/2008 by Sean Fox, MD
(Updated: 2/19/2025)
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Pediatric Back Pain
Category: Neurology
Keywords: transient neurological attack, transient ischemic attack, TNA, TIA, stroke (PubMed Search)
Posted: 1/24/2008 by Aisha Liferidge, MD
(Updated: 2/19/2025)
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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)
Posted: 1/22/2008 by Mike Winters, MBA, MD
(Updated: 2/19/2025)
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Pitfalls in pulse oximetry in the critically ill
Category: Vascular
Keywords: Pulmonary, Pulmonary Embolism (PubMed Search)
Posted: 1/21/2008 by Rob Rogers, MD
(Updated: 2/19/2025)
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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?
Category: Cardiology
Keywords: NSAIDs, aspirin, acute coronary syndrome (PubMed Search)
Posted: 1/20/2008 by Amal Mattu, MD
(Updated: 2/19/2025)
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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.
Category: Med-Legal
Keywords: Malpractice, Sued, Deposition (PubMed Search)
Posted: 1/19/2008 by Michael Bond, MD
(Updated: 2/19/2025)
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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.
Category: Pediatrics
Keywords: Ketamine, RSI, TBI (PubMed Search)
Posted: 1/18/2008 by Sean Fox, MD
(Updated: 2/19/2025)
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Ketamine and RSI for pts p TBI
Category: Neurology
Keywords: encephalopathy, neurological, mental status abnormality (PubMed Search)
Posted: 1/17/2008 by Aisha Liferidge, MD
(Updated: 2/19/2025)
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http://www.emedicine.com/neuro/topic388.htm
Category: Critical Care
Keywords: mean arterial pressure (PubMed Search)
Posted: 1/15/2008 by Mike Winters, MBA, MD
(Updated: 2/19/2025)
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Mean Arterial Pressure
Category: Vascular
Keywords: PE, Pulmonary Embolism (PubMed Search)
Posted: 1/14/2008 by Rob Rogers, MD
(Updated: 2/19/2025)
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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.
References:
(1) Kline-Carolinas Medical Center (2) Journal of Thrombosis and Hemostasis 2007 (3) AJR 2006,2007
Category: Cardiology
Keywords: atrial fibrillation, ST-segment depression (PubMed Search)
Posted: 1/13/2008 by Amal Mattu, MD
(Updated: 2/19/2025)
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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)
Posted: 1/13/2008 by Michael Bond, MD
(Updated: 2/19/2025)
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Ludwig’s Angina:
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:
Category: Pediatrics
Keywords: ITP, Leukemia, Steroids, IVIG, Anti-Rh(d), Bone Marrow Aspiration (PubMed Search)
Posted: 1/11/2008 by Sean Fox, MD
(Updated: 2/19/2025)
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Pediatric ITP – Bone Marrow Aspiration
Category: Neurology
Keywords: stroke, tia, prevention, recurrent (PubMed Search)
Posted: 1/10/2008 by Aisha Liferidge, MD
(Updated: 2/19/2025)
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--> 11.5% at 1 week
--> 6-15% at 1 month
--> 18.5% at 3 months
--> 8% at 1 week
--> 11.5% at 1 month
--> 17.3% at 3 months
Thom, et al. AHA Statistics Committee and StrokeStatistics Subcommittee. Heart Disease and Stroke Statistics-2006 Update. Circulation 2006; 113:e85-151.
Sacco, et al. Predictors of Mortality and Recurrence after Hospitalized Cerebral Infarction in an Urban Community: the Northern Manhattan Stroke Study. Neurology 1994;44:626-34.
Coull, et al. Population Based Study of Early Risk of Stroke after Transient Ischaemic Attack or Minor Stroke: Implications for Public Education and Organisation of Services. BMJ 2004;328:326.
Category: Toxicology
Keywords: bisphosphonates (PubMed Search)
Posted: 1/10/2008 by Fermin Barrueto
(Updated: 2/19/2025)
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With the aging population, bisphosphonate use will continue to increase. They promote bone growth by inhibiting osteoclast action and resorption of bone. Unfortunately, they have their side effects and the FDA has sent out a recent warning that affects us all:
If a patient presents with severe bone/joint pain, check the med list to see if they are on a bisphosphonate - they may not be faking the pain. This can occur days, weeks or even years after initiation of dose
Category: Critical Care
Keywords: pulmonary hypertension, hypotension, calcium channel blockers (PubMed Search)
Posted: 1/8/2008 by Mike Winters, MBA, MD
(Updated: 2/19/2025)
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Pulmonary Hypertension Pearls
We are beginning to see more and more patients with pulmonary hypertension (PAH), many of whom are on continuous IV infusions of new medications. With that in mind, here are a few pearls:
Category: Vascular
Keywords: Pulmonary Embolism (PubMed Search)
Posted: 1/7/2008 by Rob Rogers, MD
(Updated: 2/19/2025)
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Risk Factors for Pulmonary Embolism
Can you imagine one of our patients saying"Dr. Abaraham, I have what is known in the hematology community as a Factor 5 Leiden mutation"?
Category: Cardiology
Keywords: aVR, electrocardiography, prehospital, pulmonary edema, CPAP, noninvasive ventilation (PubMed Search)
Posted: 1/7/2008 by Amal Mattu, MD
(Updated: 2/19/2025)
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Category: Cardiology
Keywords: aspirin, acute coronary syndromes (PubMed Search)
Posted: 1/7/2008 by Amal Mattu, MD
(Updated: 2/19/2025)
Click here to contact Amal Mattu, MD
In the setting of an ACS, the minimum dose of ASA that should be given is 162 mg. Chewing provides antiplatelet effects slightly faster than simply swallowing, though the difference is probably not clinically significant. Enteric coated aspirin, however, clearly takes longer to work and should therefore be avoided in patients with ACS.
A dose of 325 mg does not appear to provide any further benefit beyond the 162 mg dose, though there might be a slightly higher bleeding rate. Despite that the 2005 PCI guidelines recommend a dose of 325 mg as the initial dose for patients with ACS if they are not chronically taking ASA. Otherwise, 162 mg is sufficient.