Clinical Pearls

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Posted on 10/18/2012

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THE EM PULSE

Answer

http://theempulse.org/

Posted on 08/03/2011

What are the clinical features of Kawasaki Disease?

Answer

Fever > 5 days
Polymorphous rash
Mucositis (cracked lips, strawberry tongue)
Conjunctivitis
Anterior cervical lymphadenopathy
Extremity changes

Posted on 11/30/2010

Which of the following will deliver more radiation to the fetus of a pregnant woman? A CT-angiogram or a Ventilation/Perfusion scan to rule out PE?

Answer

A CT angiogram is the radiographic test to perform when ruling out a pulmonary embolus in a pregnant woman. A CTPA will result in 0.000003-0.000131 Gy to the fetus while a V/Q scan will deliver 0.00014-0.00025 Gy to the fetus. Both doses are less than what is deemed dangerous to the fetus. The CTPA will result in overall more radiation to the mother than the VQ/.

Posted on 11/05/2010

What are the single line antimicrobial agents that may be used to treat neutropenic fever?

Answer

Antipseudomonal third-generation cephalosporin (ceftazidime)

Fourth-generation cephalosporin (cefepime)

Carbapenem (imipenem-cilastatin or meropenem)

Posted on 10/21/2010

How does a proton pump inhibitor infusion help in the management of an acute upper GI bleed?

Answer

It increases the pH of the stomach which allows the platelets to work more effectively to stop the bleeding. It does nothing to treat an ulcer in acute setting.

Posted on 10/05/2010

What are the muscles of the rotator cuff?

Answer

The muscles of the rotator cuff are the SITS muscles:

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

In patients with rotator cuff injuries, abduction, internal, external rotation and flexion below 90 degrees is limited or absent.

Posted on 09/14/2010

In a pregnant patient with APAP toxicity, should you give NAC?

Answer

The treatment of a pregnant patient that has a toxic APAP level is the same as that of a non pregnant person. NAC is critical in preventing toxicity in both the mother and the fetus. The does and administration is the same as a non- pregnant female. APAP concentrations in the fetus can be higher than the mother and can lead to fetal death. Fetal outcome is poorer in these patients, but that is thought to be secondary to direct APAP toxicity to the fetus rather than the NAC. In fact, in some observational studies indicate fetal outcome is generally better in those treated with NAC than those that are not treated with NAC. PO NAC is less available to the fetus than IV NAC. Though the concentration of NAC in the fetus may be equivalent to that of the mother, the efficacy of NAC in the fetus is unknown.

Posted on 09/05/2010

What is the ABCD2 Score for TIAs?

Answer

It is a scoring system used to determine risk of a significant CVA after a TIA. The probability of CVA in 2-7 days after a TIA increases with a higher score. Though the score should not be the only clinical guideline to determine the need for admission to a stroke unit, it can help the EP determine the need for admission vs early out patient follow up.

A (Age); 1 point for age >60 years,

B (Blood pressure > 140/90 mmHg); 1 point for hypertension at the acute evaluation,

C (Clinical features); 2 points for unilateral weakness, 1 for speech disturbance without weakness, and

D (symptom Duration); 1 point for 10–59 minutes, 2 points for >60 minutes.

D (Diabetes); 1 point

Stroke risk at 7 days:

Scores 0-3: low risk

Scores 4-5: moderate risk

Scores 6-7: high risk

Posted on 08/29/2010

What is the the difference between a Colles and a Smith fracture?

Answer

A Colles fracture is a fracture of the distal radius with or without involving the ulna where the fracture fragment has posterior (dorsal) displacement.

A Smith fracture is a fracture of the distal radius with or without involvement of the ulna where the fracture fragment is displaced anteriorly (volar). This is sometimes called a reverse Colles fracture.

Posted on 05/13/2010

What are the classic electrolyte abnormalities seen in acute adrenal crisis?

Answer

Low sodium and high potassium are classily seen in acute adrenal insufficiency. In an acutely ill patient who is on chronic steroids, and is persistently hypotensive despite aggressive fluid resuscitation one should consider acute adrenal insufficiency. Administer hydrocortisone IV to help correct the deficit. Hydrocortisone therapy is part of early goal directed therapy for sepsis. Giving hydrocortisone will interfere with cortisol stimulation test, so some consider giving dexamethasone instead.

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