Fearsome Foliage - An Overview of Toxic Plants

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Fearsome Foliage - An Overview of Toxic Plants

Spring has sprung... and so have many species of toxic plants! Poison centers across the United States receive over 100,000 reports of exposures to toxic plants annually. It is often difficult for Emergency Medicine providers to determine the quantity and time of exposure. Plant identification presents another challenge, and can even require the input of a botanist. Now that is an interesting consult! Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized in this post.

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Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

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Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

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CTs for SAH - Does Time Even Matter?

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CTs for SAH - Does Time Even Matter?

Spontaneous subarachnoid hemorrhage (SAH) is a can’t miss diagnosis for patients presenting to the emergency department with a headache. The diagnosis is associated with a 30% mortality at 30 days, and approximately 30% of survivors may have long-term neurocognitive deficits (Rincon et al., 2013). The majority of spontaneous SAH are secondary to a ruptured arterial aneurysm (80%) while non-aneurysmal SAH are often due to low pressure venous bleeds, arteriovenous malformations, and other more rare causes. This post will recap the existing literature on the diagnosis of aSAH and will focus on breaking down a recently published paper by Vincent, et al which may inform our future practice.

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Caustic Skin Injuries

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Caustic Skin Injuries

Chemical burns are also an evolving pathology, with thousands of new chemicals added to the market each year (4). Since 2000, both assault and warfare with chemical weapons have increased, although these pathologies vary based on practice location (1). For instance, chemical burns can comprise up to 14% of burns in the developing world, compared to 3% in the US and Europe (2, 5). It is therefore important to understand your local chemical burn patterns, in much the same way providers learn local patterns of antibiotic resistance.

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What Drip to Use After the Drop - Post-Cardiac Arrest Hypotension

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What Drip to Use After the Drop - Post-Cardiac Arrest Hypotension

During a cardiac arrest resuscitation, finally palpating a pulsatile flow beneath your gloved fingertips brings a sense of satisfaction like no other. But just as you go to finally breathe a sigh of relief and wipe the beading sweat off your brow, your now widening pupils focus on the patient’s steadily plummeting blood pressure. As you begin to sense your own heart palpitating, you think about medications to utilize in hopes of staving off another round of chest compressions. Since you’ve already given four doses of code-dose epinephrine, maybe an epinephrine infusion is best? You also recall that norepinephrine seems to be a popular choice in patients with shock, so maybe you should start that instead?

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Family Presence in Cardiac Arrest Resuscitations

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Family Presence in Cardiac Arrest Resuscitations

Cardiac arrests are an inevitable reality for emergency medicine providers. There is often a debate on whether family members presence during CPR will lead to more emotional burdens on the family members who witnessed these resuscitations. This study aimed to determine if there are increased rates of PTSD-related symptoms of close relatives who witnessed CPR of a family member.

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Packers, Stuffers, and Pushers

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Packers, Stuffers, and Pushers

Body packers, stuffers, and pushers may present to the emergency department (ED) for evaluation of symptoms or for medical clearance before prosecution. It is important for the ED physician to have a keen framework for diagnosing, evaluating, and treating these patients.

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Tube Thoracostomy for Hemothorax - Is a Tiny Tube Just Fine?

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Tube Thoracostomy for Hemothorax - Is a Tiny Tube Just Fine?

In this Journal Club podcast, PGY-3 Tony Fabiano breaks down a paper from the Journal of Trauma comparing the effectiveness and patient perception of pigtail catheters versus standard chest tubes for hemothorax in the setting of trauma. Is a tiny tube effective at all in draining blood from the chest?

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Do You Hear What I Hear: Tinnitus and Auditory Disturbances

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Do You Hear What I Hear: Tinnitus and Auditory Disturbances

The majority of cases of hearing loss and tinnitus are not immediately dangerous and may be safely deferred to the outpatient setting. There are, however, several etiologies of such complaints that are dangerous and require prompt evaluation in the emergency department. The approach to hearing loss and/or tinnitus in the emergency department must focus on identifying characteristics that may clue the examiner in on a potentially harmful etiology.

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Lymphedema and Its Mimics

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Lymphedema and Its Mimics

Lymphedema is a progressive pathologic condition of the lymphatic system where interstitial accumulation of protein-rich fluid leads to subsequent inflammation, adipose tissue hypertrophy, and fibrosis [1]. The direct effect of this development and its long-term complications can lead to disfigurement, decreased mobility, and significant morbidity. While the management of lymphedema typically requires long-term therapeutic interventions outside of the role of the Emergency Department, a thorough understanding of this condition and its mimics will help Emergency Physicians appropriately evaluate and manage the broad presentation of “swelling”.

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Atypical Headaches

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Atypical Headaches

Headaches account for approximately 4 million, nearly 3% of all ED visits annually. [1] We classify headaches as either primary (benign) or secondary, with secondary headaches occurring due to underlying pathology. In the ED, the goal is to alleviate symptoms safely and effectively while excluding dangerous causes of headaches. While nearly 98% of headaches in the ED are primary or benign [2], ruling out secondary causes of headaches is imperative as failing to diagnose correctly may result in significant morbidity or mortality.

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