Contributor: Adam Barkin, MD Educational Pearls: Represents less than 1% of all fractures that occur, although it has a significant mortality rate of 2-5% Typically occurs in high-energy trauma and are commonly associated with high injury severity scores and other fractures Concomitant Injuries: 50% have rib fracture 25% have clavicle fracture 30% have a spine…
Read MoreContributor: Dave Rosenberg, MD Educational Pearls: In 1951, Operation Tat-Type began tattooing adults with their blood type in an effort to prepare for rapid transfusions in the time of the Cold War and the Korean War School children in northern Indiana and areas in Utah were tattooed with their blood type beginning in 1952 under…
Read MoreContributor: Gretchen Hinson, MD Educational Pearls: Three episodes of ventricular tachycardia within 24 hours or two episodes back-to-back Treat with IV amiodarone and IV beta-blockers initially as well as IV lidocaine Correct underlying causes: IV magnesium for QT prolongation Replete potassium in hypokalemia Urgent revascularization in ischemia For refractory vtach, urgent radiofrequency ablation or stellate…
Read MoreContributor: Donald Stader, MD Educational Pearls: Opioids target kappa and NMDA receptors that can lead to central nervous system sensitization and therefore increased pain For patients with opioid-induced hyperalgesia (OIH), oral ketamine (25-50 mg) can be used to treat their pain as it targets the NMDA receptor Other treatments are IV magnesium, NSAIDs, Tylenol, and…
Read MoreContributor: Jared Scott, MD Educational Pearls: About ½ of the patients in the ED present with some form of pain One study looked at patients presenting in pain and followed up two days after discharge to determine if their pain was addressed, asking if the patient received anything for pain and if the patient refused…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Incidence 2.5-10 per million people occurring primarily in those with environmental allergens Typically occurs with mRNA vaccines in lipid nanoparticles (Moderna/Pfizer) rather than the adenovirus vaccine (J&J) Recommendation is to forego 2nd dose of the mRNA vaccine and instead get the adenovirus vaccine after weighing the risks and benefits…
Read MoreContributor: Jared Scott, MD Educational Pearls: 1-3 cases of rabies per year in US with 55,000 people per year receiving rabies prophylaxis 90% of rabies cases come from wildlife, most commonly by racoons, bats, foxes, and skunks Because of rabies prophylaxis, domesticated pets almost never have rabies in the United States Rabies is typical transmitted…
Read MoreContributor: Alicia Oberle, MD Educational Pearls: Down Syndrome with Trisomy 21 have three copies of chromosome 21 Current birth rates are around 1 in 700 births Average life span 25 years in 1980, today the average life span is 60 years of age Patients with Down syndrome require additional therapies in the first 3 years…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Droperidol for sedation in agitated patients in the emergency department was studied compared to ziprasidone (Geodon) and lorazepam (Ativan) Double-blinded RCT showed droperidol was 65% effective to get patients to a good level of sedation in 15 minutes compared to ativan and geodon which were 25-35% effective Droperidol had…
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