Emergency Medical Minute

Author: Donald Stader M.D. Educational Pearls: Coffee originates from Ethiopia. Its "active ingredient" is caffeine. Caffeine is a xanthine alkaloid used in medicine to control headache and as a neonatal stimulant. Studies have shown that coffee may increase lifespan. Overdose can be encountered in those using diet pills or concentrated caffeine pills and is treated with dialysis. References: Juliano, LM et al. "A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features." Psychopharmacology, 2004. https://www.ncbi.nlm.nih.gov/pubmed?term=15448977

Author: Peter Bakes M.D. Educational Pearls: Some common causes of monoarticular arthritis include: crystal arthropathies (gout and pseudogout), infection (septic joint), reactive arthritis and acute presentations of chronic arthritides. Lyme disease usually presents with a targetoid lesion associated with constitutional symptoms. The common triad of symptoms associated with reactive arthritis (aka Reiter's Syndrome) consists of conjunctivitis, urethritis, and arthritis. Reactive arthritis commonly presents with a history of a GU infection (often chlamydia) or GI infection (Shigella, Campylobacter, Yersinia, Salmonella). It is more common in men and those between 20 and 40 years old. Treatment for reactive arthritis is usually supportive. References: www.emedicine.medscape.com/article/331347-overview

Author: Gretchen Hinson M.D. Educational Pearls: The key imaging of a mumps patient is "chipmunk cheeks" or parotitis. The swelling can extend almost to the ears and can be extremely painful - in about 25% of cases the swelling is unilateral. Other organs can be involved as well including: testicles, ovaries, breast tissue, other salivary glands, and the brain/spinal cord. Mumps is transmitted through droplets in the air. Two immunizations will get you 88% probability immunity and one immunization will get you 78% probability of immunity. Yet, immunity can wane and there can be viral strains not covered by the immunization. Mumps outbreaks are common in the winter season because of close quarters. You can test for Mumps using an IGM blood test, (more likely to see a spike in this if the patient is not vaccinated) Buckle swabs, & Urine test. References: https://www.cdc.gov/mumps/index.html

Author: Aaron Lessen M.D. Educational Pearls: Regularly a patient's creatinine level is an important factor in determining whether a patient will receive IV contrast with a CT because it is thought that contrast can harm the kidneys and could worsen underlying kidney disease. A recent retrospective study compared the rates of worsening kidney problems between patients who received a CT scan with contrast, a CT without contrast, and no CT. The study even included patients with creatinines of up to 4 before excluding patients. The study suggested that there is no difference in the rate of worsening kidney problems between the three groups. References: http://www.annemergmed.com/article/S0196-0644(16)31388-9/fulltext

Author: Peter Bakes M.D. Dr. Peter Bakes takes us through how he developed his interest in travel medicine as well as some of the more interesting aspects of the specialty.

Author: Peter Bakes Educational Pearls: The Neuromuscular Junction (NMJ) is a neuronal synapse in skeletal muscle mediated by nicotinic acetylcholine receptors. Paralytic agents, commonly used in the ED for intubation, include succinylcholine and rocuronium/vecuronium. Succinylcholine is a depolarizing paralytic while rocuronium is a non-depolarizing agent. A newly developed reversing agent, sugammadex, can be used to counter the effects of curonium based paralytics. This is especially helpful due to the long duration of action of rocuronium (45 minutes to 1 hour) as compared to succinylcholine ( References: https://www.acep.org/Physician-Resources/Clinical/Thoracic-Respiratory/Rocuronium-vs--Succinylcholine--Which-Is-Best-/

There are many causes of syncope and a pulmonary embolism may be a commonly missed reason.

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What's the difference between an Aortic Dissection and an Aortic Aneurysm?

New information about concussion precautions for patients