Author: Dan Ostermayer

This month’s newsletter highlights the many complications of patients with a transplant.… Read more

Pepper (oleoresin capsicum) spray is a commonly used riot-control and violence suppressive agent. It was first used by Federal Bureau of Investigation personnel in the US in 1973.  Commonly encountered effects include conjunctivitis, blepharospasm, and self induced corneal abrasions. Early decontamination minimizes the irritant effects.  Although the majority of the uses do not cause life threatening clinical effects many patients in custody or after exposure present to the Emergency Room. This wiki page will help you navigate the patient who just got Maced!… Read more

Esophageal impaction can result in airway obstruction, stricture, or perforation. The perforation can be due to multiple mechanisms but is generally either mechanical (ingested bones) or via chemical corrosion (button battery). The most common sites of obstruction are the:

• Cricopharyngeus (near C6) muscle is the most common (about 75%)
• Aortic cross over the esophagus
• Lower Esophageal Sphincter

Although uncomplicated food impactions (no bones, incomplete obstruction) can be managed expectantly, it should not be allowed to remain for  > 24hrs.  Endoscopy is the only difinitive method to ensure removal but carbonated beverages and glucagon can be considered. Only one RCT of glucagon with 24 patients compared glucagon to diazepam and found no difference in the need for endoscopy.… Read more

Welcome to WikEM!  The Emergency Medicine residency directory has received a lot of attention, and we encourage everyone affiliated with a residency to take a moment and edit their residency page.  These pages give access to important information for future and current EM residents.  The directory can be edited by any registered user so if your program or country is missing, please add it in.  Like all wiki pages, you will receive a notification by email any time anyone edits your residency page.

A few examples:

• Residents can keep rotation scheduling up to date
• Residency coordinators can ensure all contact information is accurate
• Residency directors can highlight important facts for new applicants
• Graduates can read about changes to their residency page and learn that the educational curriculum

WikEM maintains a list of pages that are needed so that new and existing editors can have a place to begin writing.  Check out the needed pages section for a list of new pages to create.… Read more

A quick pearl on the INR stratified guidelines for warfarin reversal.… Read more

For April and May, editors will be completing the Bactrim for Abscess and the ALPS Trial journal club summaries. All contributions are welcome.… Read more

As an experiment, WikEM has a forum for all practitioners to join in discussion… Read more

The treatment of cutaneous abscesses classically involves the incision and drainage procedure. Historically, this procedure involves making a linear incision over the abscess cavity, followed by manual expression of cavity contents, blunt dissection to break up loculations, further irrigation with saline, and packing with gauze. However, a lack of data supports the routine use of irrigation to improve the success of the procedure and treatment of the abscess. In addition, while not typically considered, the routine use of irrigation does include some downsides: extra time and supplies, cost, and the possibility of microbiologic contamination of the patient care area and body fluid exposure to the practitioner.

The authors of this study randomized patients to I&D with or without… Read more

For diagnosing “Temporal Arteritis”, the American College of Rheumatology recommends meeting 3 of their 5 criteria.

• Age ≥ 50 years old
• New onset of headache
• Temporal artery tenderness or DECREASED temporal pulse (not related to carotid disease)
• ESR ≥ 50 mm/hr
• Artery biopsy with necrotizing arteritis or a granulomatous process with multinucleated giant cells