My Emergency Medicine Blog

1. image quality is inversely correlated to heart rate, requiring premedication with beta-blockers which some patients will not tolerate.
2. arrhythmias, ectomy, or ECG artifacts will result in degradation of image quality
   
3. extensive coronary calcification (patients with high likelihood of significant coronary calcification ie elderly, preexisting CAD) obscures the coronary artery lumen and may substantially limit analysis
4. obesity increases radiation scatter
   
5. radiation exposure is significant, 12 mSv
6. delineates anatomy only and can therefore only infer the impact of any given luminal narrowing
   

Source

Chinnaiyan, K. et al. "Cardiac CT in the Emergency Department" Cardiol Clin. 2009.

http://www.essentialslive.com/essentials-stream-2/

Thanks to Michelle Lin at Academic Life in Emergency Medicine for turning me on to this.

• ELISA for HIV antibodies
  
• Creatinine (Tenofovir-emtricitabine [Truvada] can cause nephrotoxicity)
  
• LFTs (Zidovudine-lamivudine [Combivir] can cause abnormal LFTs, neutropenia, anemia)
  
• CBC w/ diff
  
• Anti-HBs antibodies
  
• HBsAg
• HCV antibodies
  
• screening, including rapid plasma reagin (RPR), for other sexually transmitted infections
  
• consider checking HIV viral load and HCV RNA if suspect that patient may have an acute HIV or Hep C infection

Source

Landovitz, R. and Currier. J. "Postexposure Prophylaxis for HIV Infection" New England Journal of Medicine. 29 Oct 2009.

• severe diarrhea (passage of six or more unformed stools per day)
• diarrhea of any severity that persists for longer than a week
  
• fever
• bloody diarrhea
  
• multiple cases of illness that suggest an outbreak
  

Stool cultures are not routinely recommended in most cases of watery diarrhea or traveler's diarrhea.


Source

DuPont, H. "Bacterial Diarrhea" New England Journal of Medicine. 15 Oct 2009.

Common things being common, the usual sources of fever, recent travel or not, are still the usual sources. Proceed with a fever evaluation as normal but also consider sending off LFTs and a blood smear to screen for the following 6 common causes of fever after international travel.

1. Malaria - transmitted by mosquito, causes flu like illness, parasites on Giemsa-stained thick and thin smears, specific antibiotic treatment dependent on species of protozoa and sensitivity patterns
   
2. Dengue Fever - transmitted by mosquito, severe flu like illness - ie breakbone fever - +/- rash, leukopenia-thrombocytopenia-moderate elevations of LFTs, treatment is supportive
   
3. Typhoid Fever - transmitted by fecally contaminated food and water, flu like illness +/- rash, relative bradycardia (given fever), LFTs usually 2 - 3x normal, treat with fluoroquinolone
   
4. Rickettsial Infection - transmitted by arthropod vector, flu like illness +/- rash +/- eschar at inoculation site, leukopenia-thrombocytopenia-elevated LFTs, treat with doxycycline
   
5. Leptospirosis - transmitted by urine contaminated food and water, flu like illness, , most cases resolve spontaneously but can consider treatment with doxycycline, consider sending microagglutination test if confirmation of diagnosis needed
6. Hepatitis A
   

Source

Cavagnaro, C. et al., "Fever After International Travel" Clinical Pediatric Emergency Medicine. 2008.

House, H. and Ehlers, J. "Travel-Related Infections" Emergency Medicine Clinics of North America. 2008.

1 year of age or about 10 kg; earlier as long as the pads don't touch each other (to avoid electrical arcing).


Source

Roberts: Clinical Procedures in Emergency Medicine, 5th ed.

Echo to evaluate for tamponade. Rarely, patients who suffer stroke after a recent myocardial infarction can develop bleeding into the pericardium.


Source

Oliveira, J. et al. "Fibrinolytic therapy for acute ischemic stroke" Up to Date. 19 June 2009.