Contributor: Nick Hatch, MD Educational Pearls: Inhaled nitric oxide or Flolan may be considered in COVID Flolan is a prostaglandin can be inhaled or given IV These medications are classically used for right-sided heart failure, but may be used in COVID Causes pulmonary vasodilation to reduce the resistance against the right ventricle Complications include hypotension…
Read MoreEducational Pearls: Organophosphates affect the cholinergic system by inhibiting acetylcholinesterase affecting muscarinic and nicotinic receptors Symptoms include lacrimation, salivation, bronchoconstriction, blurred vision, bradycardia, bronchorrhea, emesis, and diarrhea Initially, the patient should be decontaminated to prevent further organophosphate exposure Treatment consists of atropine every 5 minutes, 1-3 mg to start and doubling the dose each time…
Read MoreContributor: Chris Holmes, MD Educational Pearls: Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the next 16 hours Brooke Formula: 2 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in…
Read MoreEducational Pearls: Recent updates to treatment guidelines increased the 250 mg ceftriaxone IM dose to 500 mg ceftriaxone IM IM dosing can be very painful, so other methods of administration can help decrease pain for patients Using IV ceftriaxone instead of IM has no significant difference in pharmacokinetics or bioavailability, so it can be considered…
Read MoreContributor: Jared Scott, MD Educational Pearls: A press release from Merck introduced Molnupiravir for treatment of mild to moderate COVID-19 The yet to be published study is a randomized control trial at around 100 different sites Reported outcomes were hospitalization and mortality from COVID and mortality from COVID Molnupiravir was found to be twice as…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Meaningful survival under 10% for out of hospital cardiac arrest The most common cause of out-of-hospital cardiac arrest is due to cardiac ischemia Study looked at whether taking patients without ST elevation who had an out-of-hospital cardiac arrest with return of spontaneous circulation (ROSC) should receive angiography upon arrival…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Classically, diverticulitis is diagnosed via CT scan and patients are discharged home on antibiotics if they are without complication The DINAMO study is a multicenter open-label RCT that evaluated if it is safe to not give antibiotics to patients with mild acute diverticulitis Found no difference in readmission, return…
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Ludwig’s Angina Chief Complaint: Neck and jaw pain HPI: 32-year-old female with a history of IV drug use, last injected methamphetamine 2 days ago, presents for 1 day of right-sided neck and jaw pain with associated swelling. She denies trauma, dental pain and sore throat. She states the pain started around lunchtime yesterday and that…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Ophthalmia Neonatorum encompasses any conjunctivitis that presents within the first 28 days of life Neonates often receive prophylactic silver nitrate eye drops for gonorrhea prophylaxis, but the drops can cause chemical conjunctivitis Etiology & Timing of Presentation: Silver nitrate conjunctivitis presents 0-2 days after birth Neisseria gonorrhae presents 2-5…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Preterm deliveries in the ED can be complex and preventing hypothermia is essential to the health of the baby Recent meta-analysis examined methods for warming preterm deliveries to prevent hypothermia The most effective way to warm the baby is by wrapping them in plastic References Abiramalatha T, Ramaswamy VV,…
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