Resus SinaiEM Blog – Page 23

52 in 52 Review: PE Rule Out with Wells and D-dimer

Posted on December 1, 2017 by Xiao Han

Title: “The 52 in 52 Review: PE Rule Out with Wells and D-dimer” Article Citation: Wells PS, Anderson DR, Rodger M, Stiell I, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Annals […]

Modified Valsava for SVT

Posted on November 30, 2017 by Xiao Han

Background: SVTs are commonly seen in the ED. Chemical cardioversion often takes several minutes to initiate because we have to get IV access and medication ready. During this time, we can attempt some valsava maneuvers to cardiovert stable patients. Current valsava maneuvers have shown low efficacy 5-20%. The REVERT trial compared the standard Valsava to […]

BiPAP

Posted on November 28, 2017 by Xiao Han

What’s the difference between BiPAP vs. CPAP? CPAP stands for continuous positive airway pressure. In other words, there is a continuous pressure regardless whether the patient is breathing in or out. CPAP only has one pressure setting. BiPAP has two pressure settings: inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). While the […]

ADvISED Trial

Posted on November 24, 2017 by Xiao Han

Background: Acute aortic syndromes (AAS) include aortic dissection, intramural aortic hematoma, penetrating aortic ulcer and aortic rupture. AAS are rare but life threatening cardiovascular emergencies with non-specific clinical presentations, which results in overtesting and misdiagnosis. The ADvISED Trial introduces a new clinical strategy that combines a Pre-test Probability Assessment with a D-dimer to help physicians […]

4 reduction techniques of anterior mandible dislocation

Posted on November 21, 2017 by Xiao Han

4 Reduction Techniques of Anterior Mandible Dislocation Classic intra-oral reduction Place thumbs over the patient’s inferior molars Apply downward force and then guide the mandible posteriorly Wrist Pivot Method Place thumbs at the chin Place other fingers on the inferior molars Pivot your wrists Syringe Place a syringe between the molars of one side Ask […]

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Hyponatremia

Posted on November 20, 2017 by Xiao Han

Clinical Scenario: 28 yo F with unknown medical history presents with multiple seizures. Routine BMP shows hyponatremia to 110. What is your next step for symptomatic hyponatremia? Causes of hyponatremia: Hypervolemic Hyponatremia: congestive heart failure, cirrhosis, chronic renal failure Euvolemic Hyponatremia: SIADH, hypothyroidism, adrenal insufficiency Hypovolemic Hyponatreamia: fluid loss via the gastrointestinal tract, diuretics, renal […]

Codeine is bad for children

Posted on November 17, 2017 by Sam Schuberg

Despite warnings by the FDA in 2013 to stop prescribing codeine to children due to the risk of respiratory depression and death, a study to be released this week in Pediatrics indicates that 5% of children post-tonsillectomy/adenoidectomy are still being prescribed this medication. Why is codeine so dangerous? Codeine is metabolized to morphine […]

52 in 52: PECARN tool to identify pediatric patients with low risk head injuries

Posted on November 16, 2017 by Sam Schuberg

Article Citation Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. What we already know about the topic According to the CDC, […]

Presentation of acute aortic dissections

Posted on November 14, 2017 by Sam Schuberg

A 91 yo female presents with sudden onset right arm pain with decreased pulses. Since arrival to the ED, her mental status has also progressively decreased. Her blood pressure is 170/60, HR 60, T97.8, RR20, sats 100% RA. You suspect she has had an aortic dissection and indeed a CTA of her chest / abdomen […]

Combination of acetaminophen and ibuprofen for acute extremity pain

Posted on November 13, 2017 by Sam Schuberg

Article Citation Chang AK et. al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial.JAMA. 2017 Nov 7;318(17):1661-1667. doi: 10.1001/jama.2017.16190. What we already know about the topic According to the latest CDC data from 2015, opioids were involved in […]

IUDs and the risk for ectopic pregnancy

Posted on November 10, 2017 by Sam Schuberg

17 yo female with progestin secreting IUD, LMP 9/22/17, no prior medical problems presents to the ED with bilateral lower abdominal pain for the last day. She also notes that she has had some intermittent vaginal bleeding for the last 3 weeks. Her HR is 98, BP 130/99, RR16, sat 100% on RA. On exam […]

The 52 in 52 review: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Posted on November 9, 2017 by Sam Schuberg

Article Citation Hacke W, Kaste M, Bluhmki E, Brozman M, et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. PMID: 18815396 What we already know about the topic Last week we reviewed the 1995 NINDS trial that showed that t-PA given […]

Fight bite

Posted on November 7, 2017 by Sam Schuberg

21 yo male presents with laceration over his distal 4th metacarpal. Initially the patient doesn’t recall how the injury occurred, but with additional probing you discover he was in an altercation last night and punched another person in the mouth. A x-ray shows no fracture and no retained foreign body. What do you do now? […]

Oculomotor palsy

Posted on November 6, 2017 by Sam Schuberg

A 74 yo female with hx of diabetes, HTN presents to the ED with new onset painless left sided diplopia for the last 24 hours. No change in visual acuity. The patient has no other symptoms. You examine the eye and left sided ptosis and a “down and out pupil”. The pupil is reactive to […]

The 52 in 52 Review: Tissue Plasminogen Activator for Acute Ischemic Stroke

Posted on November 2, 2017 by Sam Schuberg

Article Citation: The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute iscAhemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7.PMID: 7477192 What we already knew about the topic: According to the AHA, around 800,000 people a year in the United States experience a stroke, whether first time […]