Author: Nick Hatch, MD Educational Pearls: The sodium-glucose cotransporter in the gut is essential for rehydration. Oral rehydration therapies require an equimolar concentration of glucose and sodium to be effective. ORT has saved millions of lives globally. Consider using ORT in patients with dehydration. Especially useful in resource limited settings. References: Victora CG, Bryce J,…
Read MoreAuthor: Dylan Luyten , MD Educational Pearls: Rare autosomal dominant condition that is often misdiagnosed as a psychiatric illness. Presents as profound muscle weakness with frank paralysis that is often precipitated by vigorous exercise, high carb diet, high sodium load, or by high temperatures. Supplemental potassium can rapidly reverse symptoms. Important to rule out thyrotoxicosis…
Read MoreAuthor: Don Stader, MD Educational Pearls: The use of fecal occult blood tests is falling out of favor in emergency departments These tests have strong evidence suggesting their efficacy in colon cancer screening but clinical significance in ED is limited They have relatively high false positive and false negative rates Small/microscopic bleeding are often…
Read MoreAuthor: Rachel Beham, PharmD Educational Pearls: Some synthetic cannabinoids have been contaminated with Brodifacoum. Brodifacoum is a Vitamin K antagonist and can present with a severe coagulopathy. Brodifacoum is commonly known as “superwarfarin” and has a very long half life of 120+ days. Check PT/INR in patients with a bleeding diathesis in setting of synthetic…
Read MoreAuthor: Jared Scott, M.D. Educational Pearls: Cardiac myocytes and vascular smooth muscle are dependent on an intracellular calcium influx for contraction. Pancreatic beta cells rely on calcium to release insulin. Calcium channel blockers will decrease cardiac contractility and heart rate, but will also cause vascular smooth muscle relaxation with a subsequent decrease in systemic vascular…
Read MoreAuthor: Nick Hatch, M.D. Educational Pearls: Methemoglobinemia is when the iron in hemoglobin is in the Fe3+ (ferric) state rather than the normal Fe2+ (ferrous) state. Methemoglobin cannot release oxygen at the tissues. Symptoms include cyanosis, headache, tachycardia, dyspnea, and lethargy. Suspect in setting of hypoxia that does not improve with oxygenation, and clinical cyanosis…
Read MoreAuthor: Dylan Luyten, M.D. Educational Pearls Lactate is a byproduct of anaerobic metabolism, a sign of dying tissue. Dangerous causes of high lactates will not normalize with repeat labs. Crush injuries, seizures, bowel necrosis, end-stage liver disease, and metformin toxicity are common causes of highly elevated lactate. References: https://lifeinthefastlane.com/ccc/lactic-acidosis/
Read MoreRun Time: 5 minutes Author: Eric Miller M.D. Educational Pearls: TTP stands for thrombotic thrombocytopenic purpura. TTP patients usually have renal failure, bruising or petechia, anemia, confusion, and other neurologic changes, which distinguishes itself from ITP which is mostly characterized by just low platelets and petechia. Both TTP and ITP are thought to be autoimmune…
Read MoreRun Time: 4 minutes Author: Dr. David Rosenberg Educational Pearls: A patient presented with left arm swelling with a history of a right pneumonectomy due to lung cancer. The patient received a NIVA of the arm and was discharged upon normal interpretation of the exam. The patient returned the next day with worsened arm…
Read MoreRun Time: 3 minute Author: Dr. Samuel Killian Educational Pearls: 5 million people are on Coumadin. Coumadin is in the top 5 of most adverse events. 2 options for reversal in the ER: Vitamin K and FFP or vitamin K and 4 factor PCC. FFP is cheap but harder to use and takes longer –…
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