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Emu July 2012

Emu July 2012

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Published by precordial_thump

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Published by: precordial_thump on Aug 28, 2012
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01/16/2013

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EMERGENCY MEDICINE UPDATE
July 2012
DON'T LET THIS BE YOUR LAST ISSUE OF EMU-IF YOU ARE AFINISHING RESIDENT SEND US YOUR NEW E MAIL ADDRESS!
1)
Traumatic brain injury is catastrophic- just ask Marie Antoinette(true, that was a dislocation and not a true head injury). The questionin this study was whether patients did worse if there was a 60 minutetransit time, or they did worse when there was a need to be broughtto a level one trauma center, hypoxia, hypotension, hyperventilation,or tachycardia. They claimed they did not ( Acta Anes Scand55(8)944). The take home point here is that it really doesn't matterwhat intervention is done in head injury- they all do pretty poorly. Theproblems with his study were they only had 46 patients in 3 years, andI did not see a definition of what is a severe head injury (I am not abig lover of the GCS scale). However, where this can be relevant isthat your trauma center can function fine even if you do not haveneurosurg backup. Of course, it is the few that are not that severethat may respond well if you have neurosurg backup but those inmany cases can just be transferred. TAKE HOME MESSAGE: Severehead injury does poorly no matter what factors are involved.
2)
 A call for doing surgical airways, I was waiting for the answerwhy we are so reluctant to do these airways and finally found it in thelast line of the abstract- because of the perception that if you can'tintubate a particular patient- you must be an idiot. The truth is exactlyopposite. No, not that if you can intubate you are an idiot but rather if you can't do a surgical airway you are an idiot. A few of you may beidiots no matter what you do (no, I do not mean you; but I do meanyour boss). But if at least you know how to properly do a surgicalairway you will be an intelligent idiot. And probably save some one's
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EMERGENCY MEDICINE UPDATE
life. ( Anest Int Care 39 (4)578) TAKE HOME MESSAGE: There aredefinitely people who are intubation nightmares and you must knowhow to do a cric. And not only know how to but actually do it.
3)
 Yucky study. You would think if you put a hand sanitizer in thehospital cafeteria, that health care workers would use it. Well, in 5500visits to the cafeteria- only 4.79% actually used it. So they used aposter to remind people- yea that is the ticket- and sure enoughfrequency of use increased- that is what they want you to believe inthe conclusion of the paper. However, this improvement was onlyseen in visitors to the hospital cafeteria, not in the actual workers. ( AmJ Inf Contr 39 (6)464) By the way I love to cook and now is theopportunity to give a plug for my book "You Can Make Hospital Foodat Home" TAKE HOME MESSAGE: For Goodness sake at least washyour hands before you eat in the hospital.
4)
This may not be relevant to your practice but it is very relevantto mine where patients often present with questionable indications forbenzo use requesting I renew their prescription for these meds. Soyou have to know this- they cause dependence, cognitive andpsychomotor impairment and ultimately possible long term brainchanges. The risk benefit ratio is favorable only with short term use.Nowadays there are safer alternatives for most of the benzoindications. ( Addiction 106(12)2086). I have been told that if you readEMU you must be on drugs- try not to make them benzos. TAKEHOME MESSAGE: Benzos can be risky especially in long term use.There are safer alternatives in most instances.
5)
When the new residents in the USA take over in July- mortalitygoes up and efficiency goes down in their meta analysis. This is asystems problem that requires addressing. In many European
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EMERGENCY MEDICINE UPDATE
countries residencies open up here and there and they do not all startin July. ( Ann Int Med 155(5)309). This is a very poor meta analysis asthe data is really diverse, but I believe the results. TAKE HOMEMESSAGE: Don't go to the hospital in July. Never go the Hospitalcafeteria anytime. Never be an idiot.
6)
OK enough already. I know you know your stuff and promisenot to call anyone an idiot anymore. But you can still prove yourself. A patient who is 25 years old comes to the ED with weakness andpainful swallowing over the distribution of the carotid artery. Theycomplain of chest pain and there may be hypertension. Treat thisearly and you will prevent permanent damage. (QJM 104 (9)797). Andthe diagnosis is……
7)
The results of this study are fascinating and they are relevant toFPs as well. Often females have normal cardiac caths. Yet they stillhave chest pain and can even infarct- this is supposed to be fromulceration or plaque rupture or even spasm. All the patients in thisstudy had ST elevation and there were only a smattering that hadnormal coronaries so you can't take this study home , but it is worthremembering- a normal cath means little when the clinical picture fitsa more serious entity (Circ 124 (13)1414) TAKE HOME MESSAGE:Normal cath means little when the clinical picture looks suspicious.
8)
The tile of the paper is cool, but the message is important. Doyou know what a pseudo pseudo seizure is? Neuro psychiatricsymptoms with a normal EEG that could fit a pseudo seizure do notmean you are done and this is not a real seizure. This was a case of auto immune encephalitis due to ovarian cancer. (Psychosomatics52(6)501) You can never take much out of case reports but do not buythe pseudo seizure concept so quick- especially because many patients
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