Author: John Winkler, M.D. Educational Pearls Angioedema is immediately life-threatening due to airway obstruction. Mechanisms include allergic reaction (histamine-related) or bradykinin-related (ACE-inhibitor, C1 esterase inhibitor deficiency). The bradykinin-related mechanism will not respond to the traditional meds used for anaphylaxis. Instead, use FFP to replace depleted factors. If a patient displays signs of respiratory compromise, intubation…
Read MoreAuthor: Aaron Lessen, M.D. Educational Pearls Icatibant was introduced to treat ACE-inhibitor induced angioendema. This type of angioedema is refractory to epinephrine and antihistamines, and is likely mediated by elevated bradykinin.(which is inactivated by ATII and ACE). Icatibant initially was shown to reduce facial swelling and airway obstruction in the setting of ACE-I angioedema, but…
Read MoreAuthor: Sam Killian, M.D. Educational Pearls Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours. Biphasic happens in patients that have a complete resolution of their anaphylaxis for at least an hour, but then have a recurrence that requires pharmacologic intervention. Most of the time this happens…
Read MoreAuthor: 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…
Read MoreRun Time: 5 minutes Author: Peter Bakes M.D. Educational Pearls: Case presentation: 18 year old otherwise healthy male presents to the ED complaining of neck stiffness, headache, and right ankle irritation. The patient recently traveled to Italy in an area endemic of Lyme Disease. The patient 2 weeks prior had a viral infection w/ rhinorrhea…
Read MoreRun Time: 2 minutes Author: Dr. Nicholas Hatch Educational Pearls: Angioedema is usually caused by an allergic reaction and can be induced by ACE inhibitors as well as tissue plasminogen activator (TPA). Angioedema is caused by the build up of bradykinins resulting in the leaking of capillaries and swelling of tissue. TPA-induced angioedema is reported to…
Read MoreRun Time: 5 minutes Author: Dr. Jared Scott Educational Pearls: Urticaria means “burning nettles” in Latin. Lymph nodes release immunoglobulin IgE and IgG, which trigger mast cells located all over the body to release histamines. Along with the well-known acute urticaria, there are chronic types of urticaria, which last longer than six weeks. There are…
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