Ep 17 Roshcast Emergency Board Review

02.16.2017 - By Emergency Medicine Board Review

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Put your heart, mind, and soul into even your smallest acts. This is the secret of success.   –Swami Sivananda

Welcome back to Episode 17! This is part 2 of the 3 part ITE rapid review series. In Episode 16, we covered abdominal emergencies, cardiovascular emergencies, cutaneous emergencies, endocrine emergencies, and environmental emergencies. Today we jump right in with HEENT emergencies. Let’s get started! 

HEENT Emergencies

* The target pH for eye irrigation after a chemical burn is 7.0–7.2. Alkali burns usually cause more damage than acidic burns due to liquefactive necrosis.* Acute glaucoma classically presents with a red, painful eye, blurry vision, and asymmetric pupils. First line treatment options include beta-blockers, carbonic anhydrase inhibitors, steroids, and miotics.* Corneal abrasions should be treated with topical antibiotics such as erythromycin or ciprofloxacin. Tetanus vaccination should also be updated if needed.* The three most common bacterial causes of acute otitis media are Streptococcus, Haemophilus, and Moraxella. However, viral pathogens are far more common. If treating with antibiotics, the first line is typically amoxicillin.

Hematologic Emergencies

* Angioedema secondary to ACE-inhibitor use occurs due to a buildup of bradykinin.* Hereditary angioedema is caused by a deficiency or dysfunction of the C1 esterase inhibitor. Episodes are typically precipitated by stress or trauma. Treatment is with replacement of C1 esterase inhibitor or with FFP if the inhibitor is not available.* TTP is treated with plasmapheresis. If plasmapheresis cannot be performed expediently, FFP can be used as a temporizing measure.* For any patient on warfarin with a life-threatening bleed, FFP, PCC, or recombinant factory VIIa should be given. For a patient on aspirin with a life-threatening bleed, DDAVP should be given in addition to platelets.* Predisposing risk factors for DVT include malignancy, immobilization, recent surgery, obesity, smoking, oral contraceptives, recreational drugs, and hypercoagulable states.* Chronic alcohol abuse leads to a macrocytic anemia and even pancytopenia due to ethanol’s suppressive effects on the bone marrow.* Patients on long-standing isoniazid are at risk for sideroblastic anemia due to a pyridoxine deficiency.* Vitamin B12 deficiency causes a megaloblastic anemia called pernicious anemia. It usually occurs secondary to absorptive problems rather than poor dietary intake.* Giant Cell Arteritis commonly presents with unilateral temporal headache, jaw claudication, tender temporal artery, and even sudden painless monocular vision loss. The ESR is usually between 50-100. 50% of patients with giant cell arteritis also have polymyalgia rheumatica.* Giant cell arteritis should be treated with immediate steroids, long before biopsy confirms the diagnosis.* In giant cell arteritis, aortic involvement can lead to valvular disease and dissection.* Both hemophilia A and B are x-linked recessive diseases. Hemophilia A is caused by decreased synthesis of factor VIII. Hemophilia B or Christmas disease is caused by decreased synthesis of factor IX. Treatment is with specific factor replacement or if unavailable, with cryoprecipitate.

Immune System Emergencies

* For a new mother with mastitis, she should be advised to continue nursing from the affected breast. Dicloxacillin is the antibiotic of choice.* Prophylaxis for Neisseria meningitidis should be offered to high-risk contacts,

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