You may have noticed algorithm diagrams supplementing various topics on WikEM. They’re part of the WikEM Algorithm Project, a continuing partnership with ddxof.com (differential diagnosis of). The WikEM algorithms are developed to serve as rapid emergency department references for differential diagnosis generation, clinical decision rule application, and critical management steps. They also serve as convenient teaching tools for educators.

You can now freely access all of the over 100 algorithms on your mobile device with the ddxof app. Download it today on the App Store and Google Play.… Read more

• Negative-pressure pulmonary edema (NPPE)  occurs after a patient makes strong inspiratory effort against a blocked airway. The negative pressure causes hydrostatic edema that can be life-threatening if not but minimized if treated early, usually resolves after 24-48 hours.
• Patients have and airway obstructive process either from an allergy, laryngospasm, trauma, and commonly in the case of hangings.

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

You get a patch from EMS that they are bringing in a patient from dialysis with a complication of their AV fistula. Take the time now to update yourself on bleeding fistulas, clotted fistula, and more at WikEM – Dialysis Complications.… Read more

Dosing emergent factor replacement in the management of hemophilia (A &B) requires a small amount of mental math.

• For Hemophilia A: 1 IU rFIX/kg will increase the plasma concentration by 2%
• For Hemophilia B: 1 IU rFIX/kg will increase the plasma concentration by 1%

As winter is upon those in the United States, make sure you are treating your patients with pneumonia using the appropriate antibiotics.   Outpatient treatment is divided among those with significant comorbidities and those without.  The inpatient regimens distinguish between hospital associated, community acquired and those requiring the ICU.… Read more

One of the newest drugs available to some EM provider is Sugammadex.  Trade name, Bridion, the drug functions as a reversal agent for Rocuronium.  An IV bolus of 16 mg/kg over 10 seconds via a central or peripheral line will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.  Although rarely used in the emergent setting, keep the dose in the back of your mind or reference on the WikEM app just incase you need to order it.… Read more

Neonatal jaundice is one of the most common reason for newborns to return the hospital.  There are many risk factors and causes, with the most important piece of the workup being distinguishing direct vs indirect hyperbilirubinemia. Indirect hyperbilirubinemia can point towards a usually benign cause with breast feeding, breast milk and physiologic jaundice being the most common causes and present within the first 4-7 days of life.  Useful tools for risk stratification include the Bilitool for evaluating need for phototherapy.… 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:

• Cancer
• Pregnancy
• Local infections (otitis media, sinusitis, cellulitis)
• Hypercoagulable states
• Trauma
• 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 CT venogram… Read more