The June Newsletter is out. Topics include hemophilia, Lyme disease, mammalian bites, and arthritis.… Read more
Author: Dan Ostermayer
Telemetry Monitoring: Who needs it?
Which of the following patients does not warrant monitoring with telemetry after admission to the hospital?
A. AICD firing
B. Type II and complete heart block
C. Decompensated heart failure
D. Acute cerebrovascular accident
E. Massive blood transfusion
F. All of the above warrant monitoring
…an excerpt from The Kaji Review
Reference:
LLSA 2009: Chen EH and Hollander JE. When do patients need admission to a telemetry bed? J Emerg Med. 2007; 33(1): 53-60. full text… Read more
Vasopressors
The goal of vasopressor use is to reach critical organ perfusion pressure. Estimated required mean arterial pressures (MAP) are listed in the vasopressor review by organ. It is generally safe to aim for a goal map of 65 mmHg. Vasopressors also promote increased venous return and should be used in septic patients after failed response to adequate volume resuscitation.… Read more
Thryoid Storm
Scott Weingart has put out a great EMCrit Podcast on the treatment and diagnosis of Thyroid Storm. With thyrotoxicosis and thyroid storm being relatively rare diseases, wiki page highlights the treatment and diagnosis. The severity of hyperthyroidism, thyrotoxicosis and thyroid storm can be assessed with the Burch-Wartofsky score. Treatment is focused on: Aggressive supportive care and early propranolol administration to decrease peripheral hormone conversion and decrease sympathetic surge. Also along with propranolol, thionamide administration (specifically PTU) blocks new hormone synthesis. Iodide can be administered afterwards to prevent further hormone production.… Read more
Treatment of Ureteral Calculi
Regarding ureteral calculi, which of the following is FALSE?
A. The incidence of kidney stones in the general population appears to be increasing, as does the medical cost associated with this disease.
B. The majority of individuals with urolithiasis have small (<5 mm) stones, located in the distal ureter, that are able to pass spontaneously.
C. Both stone expulsion and time to expulsion of ureteral stones depend heavily on stone size and location.
D. Urologic intervention is recommended for ureteral stones that persist for more than 2 months.
E. A meta-analysis demonstrated that neither calcium channel blockers nor alpha-antagonists increase the rate of stone passage.
excerpt from The Kaji Review … Read more
What is the risk of HIV post exposure?
A 24 yo male presents to the ED saying that he had receptive anal intercourse without the use of a condom with an male partner who was known to have had sex with other men. He is also worried because many years ago she was not treated for a needlestick injury. TRUE statements about postexposure prophylaxis (PEP) for HIV include which of the following?
(Choose three answers.)
A. A case-control study in 1997 demonstrated that health care workers who received AZT after needlestick exposures were 81% less likely to undergo seroconversion to positivity for HIV.
B. The use of PEP does not assume that the person who was exposed to HIV is HIV negative.
C. The overall rate of HIV transmission through percutaneous inoculation through a needle is reported to be 0.3%.
D. The estimated risk of transmission from receptive… Read more
PID and Hospitalization
Regarding pelvic inflammatory disease (PID), which of the following is NOT a criteria for which hospitalization should be considered?
A. Pregnancy
B. Tuboovarian abscess
C. Vaginal bleeding
D. A surgical emergency can not be excluded (e.g., appendicitis).
E. The patient is unable to tolerate an outpatient oral regimen.
…an excerpt from The Kaji Review … Read more
Demystifying the Editorial Levels of WikEM
All content on WikEM is reviewed by editors who are committed to content quality and correctness. The WikEM organization is extremely egalitarian with an open and transparent promotion process. The more your contribute to the wiki, the greater your level of influence and recognition within the organization. The wiki software tracks contributions and ranks authors based on contribution
- Casual users can contribute small changes
- Residents can participate individually or as part of a residency elective
- Any physician can advance through the official editorial levels.
As more content moves to the internet on platforms other than textbooks and journals, WikEM will use metrics such as these to advance the academic and educational careers of our contributors.… Read more
Sponsorship: MedNexus
WikEM is proud to announce this week’s sponsor, MedNexus, a search engine designed for healthcare providers. They are developing a really exciting set of tools using semantic search to create a “Google for Medicine”. Their search and discovery tools allow a provider to quickly find the most relevant articles, reviews, guidelines, and medical content to answer clinical questions while caring for patients.
The power of their system rests in a sophisticated ranking system to organize content by quality and relevance. This means their results are not only more targeted to your clinical question but also of greater quality than a stand web search.
MedNexus offers a web search portal, iOS app, and they have an Android version on the way! We also had the privilege of talking… Read more
DKA and Cerebral Edema
Which of the following is NOT a risk factor for cerebral edema in diabetic ketoacidosis (DKA)?
A. Elevated blood urea nitrogen
B. Low serum potassium on presentation
C. Treatment with bicarbonate
D. Age < 3 years
E. Failure of serum sodium to rise steadily with correction of hyperglycemia
…an excerpt from The Kaji Review … Read more
