Modified Valsalva Maneuver for SVT Chief Complaint: SVT HPI: Patient is a 49-year-old male with history of prior episodes of SVT and HTN. He stated that over the past 5 years he’s had approximately one episode every 6 months. He stated that a cardiologist instructed him that he should have an ablation that he likely…
Read MoreContributor: JP Brewer, MD Educational Pearls: Obtaining collateral is often vital to determine the potential drugs accessible to the patient – this may include medications found in their medicine cabinet prescribed to them or a family member After this, use ancillary sources such as EMS, family/friends, and police to determine the patient’s last normal, PMH…
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Contributor: JP Brewer, MD Educational Pearls: Because of their smaller size, there are a variety of adult-dose pills that are potentially toxic to children. The most common categories of medications that may be toxic include cardiac, diabetic, pain, psychiatric, anti-malarial, and herbals/caustics Oral hypoglycemics such as sulfonylureas can be particularly dangerous in children. Opiates and…
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Contributor: Don Stader, MD Educational Pearls: Buprenorphine is a partial Mu-agonist and binds with higher affinity than most opioids Pain management with opioids therefore can be difficult in patients taking buprenorphine Ketamine is a good option for pain control in these patients You can also consider using additional buprenorphine Intravenous buprenorphine is dosed differently than…
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Educational Pearls: Buprenorphine is a semi-synthetic derivative of the opium poppy FDA approved for the treatment of opiate use disorder and chronic pain Benefit in emergency department use is the ceiling effect – producing less euphoria as well as respiratory depression with higher doses It has an onset of 30-60 minutes, peak effect at 1-4…
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Contributor: Don Stader, MD Educational Pearls: Syncope is usually benign but can be caused by serious etiologies which include: PE, certain cardiac arrhythmias, AAA, intracranial bleed/stroke The Canadian Syncope Rule appears to identify those patients with syncope and low risk of serious outcomes The score is based on vital signs, EKG and history Negative scores…
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Contributor: Jared Scott, MD Educational Pearls: The CDC recommends rabies prophylaxis if there was a direct encounter with a possibly rabid animal except… Bats are treated differently since their bites may be very superficial and not seen/felt. All people with possible close encounters with a bat should receive rabies prophylaxis From 1990-2007 there were 34…
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Contributor: Nick Hatch, MD Educational Pearls: Dalbavancin (Dalvance®) is an antibiotic that can be used for skin and soft tissue infections, providing MRSA coverage It cannot be used in other infections or sepsis Dalbavancin may be appealing as a single dose lasts about 2 weeks Expense is currently a large barrier to use Patients with…
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Contributor: Michael Hunt, MD Educational Pearls: Due to the efficacy of vaccination, epiglottitis is now more common in adults than children Risk factors include smoking and other immunocompromising co-morbidities, such as diabetes Epiglottitis can present with sore throat and fever, with potential rapid progression to respiratory distress and stridor Diagnosis can include x-ray to look…
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Contributor: Nick Hatch, MD Educational Pearls: True morel mushrooms are commonly foraged The false morel mushroom (Gyromitra esculenta) looks similar to the true morel, but is toxic False morel mushroom toxicity can cause gastrointestinal symptoms as well as liver failure, rhabdomyolysis, and seizures Seizures can be refractory to benzodiazepine therapy and may require use of…
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