Tetrodotoxin is from the pufferfish, blue octopus and some poisonous frogs. Neurotoxicity results from inhibition of Na-K pumps causing paresthesias and rebound hypersensitivity. Like most poisons in toxicology, the treatment is aggressive supportive care.… Read more
The following guest post is written by MD candidate Joseph N. Ponce at McGovern Medical School, Houston TX, and describes the current state of evidence with adjunctive techniques to treat refractory VF.
Refractory ventricular fibrillation (RVF) is a life-threatening cardiac arrhythmia unresponsive to traditional methods of defibrillation and advanced cardiovascular life support (ACLS). Current literature lacks a uniform definition for RVF, however, some studies provide more specific clinical definitions of refractory ventricular fibrillation such as ventricular fibrillation that is resistant to at least three defibrillation attempts, 300 mg of amiodarone, and does not exhibit return of spontaneous circulation (ROSC) after > 10 min of cardiopulmonary resuscitation (CPR).… Read more
Cerebral venous thrombosis (CVT) is a rare disorder involving occlusion of the venous sinus (most commonly superior sagittal and lateral sinuses) . CVT is a very difficult diagnosis with a highly variable onset that may include visual, neurologic or even infectious like symptoms. Predisposing factors include:
- Local infections (otitis media, sinusitis, cellulitis)
- Hypercoagulable states
- Drugs (ecstasy, androgens, OCPs)
- Compression of venous sinus (tumor, abscess)
Suspect CVT in patients presenting with headache, signs of increased ICP, or focal neurologic deficits, especially if any of above predisposing factors are present. Do not use a D-dimer to rule out CVT. The workup includes, an MRI and MRV unless there is a contraindication, then… Read more
We are always working to make bedside knowledge more accessible and quickly available for clinicians and healthcare providers in emergency settings for free.
- Over the weekend our iOS app received a major update to fix many bugs and improve the appearance of content.
- The website has quick links to the critical care quick reference, antibiotic guide, journal club, and popular pages
- The forum is available for discussion anything Emergency Medicine and new EM job postings
- The newsletter provides monthly updates on educational topics and highlights learning resources on the internet
We keep all content free because were realize how important information and knowledge sharing is to daily clinical practice and because our users are our patrons and keep everything running.… Read more
The AAP has formally changed the name of ALTE to Brief Unexplained Event (BRUE). The definition has also been formalized with more specific criteria and suggestions to empower the clinician to base the diagnosis on their suspicion rather than relying only on the caregiver’s history.
BRUE is an event occurring in an infant <1 year of age when an observer reports a sudden, brief (<1 min), and now resolved episode of ≥1 of the following without explanation:
- Cyanosis or pallor
- Absent, decreased, or irregular breathing
- Marked change in tone (hyper- or hypotonia)
- Altered level of responsiveness
- Must have returned to baseline
Many non illicit drugs cross react with common drugs screened on the traditional urine drug screen.
- NSAIDs can cause false positive cannabinoid screens
- Sertraline can cause a benzo false positive
- Most benzodiazepine screens look for oxazepam which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.