Thursday, October 17, 2019

Resident Journal Review: Neurologic Complications of Correction for Hyperglycemic Hyperosmolar State in the Emergency Department

Authors: Mark Sutherland, MD, Megan Donohue, MD, Caleb Chan, MD, Robert Brown, MD
Editors: Kami M. Hu, MD FAAEM; Kelly Maurelus, MD FAAEM
Originally published: Common Sense September/October  2019

  1. What is the preferred therapy for correction of hyperglycemic hyperosmolar states (HHS) in the emergency department, and what potential adverse neurologic effects of these corrective therapies should be considered?
  2. What is the incidence of osmotic demyelination syndrome (ODS) or cerebral edema when aggressively correcting hyperglycemic states?
  3. Who is at greatest risk for ODS and what can be done to reduce their risk?
  4. Who is at greatest risk for cerebral edema and what can be done to reduce their risk?

Friday, October 11, 2019

Case report: A rare case of acute lumbar paraspinal compartment syndrome in a military trainee

Image by: Airman st Class Janelle Patio
This post was peer reviewed.
Click to learn more.

Author: Conner Murphy, MSIV, Ivan Yue, MSIV, and Vivek Abraham, MSIV
Uniformed Services University School of Medicine
AAEM/RSA Publications and Social Media

Acute lumbar paraspinal compartment syndrome is a rare injury, occurring primarily in male patients and often related to overhead weight lifting activities.[1] It has also been reported following skiing, surfing, blunt trauma, and as the result of reperfusion injury following abdominal aortic procedures.[2] The syndrome occurs when the enclosed fibro-osseous space of the lumbar paraspinal compartment increases in pressure beyond perfusion pressure, leading to ischemia, intractable pain and eventually tissue necrosis if left untreated.[1] Patients generally present with intense acute pain after exercise, physical exam revealing swollen and tense lumbar paraspinal muscles, and laboratory abnormalities including high creatine kinase levels and myoglobinuria, often appearing like or in conjunction with rhabdomyolysis.[2] Muscle tissue may remain viable for up to four hours without irreversible damage, while eight hours of ischemia has been known to cause irreversible necrosis.[3] Early recognition and orthopedic consultation for surgical management decreases prolonged suffering and neurovascular compromise, allowing resolution of rhabdomyolysis and pain, as well as return to baseline athletic activity.[4] In this case report, we present a case of acute lumbar compartment syndrome in a young athletic male in the context of intense military training.

Thursday, October 3, 2019

CPR Induced Consciousness – An Important Phenomenon to be Aware Of

Image credit: Pexels
Author: Jake Toy, DO
Harbor UCLA Medical Center
Originally published: Common Sense July/August 2019

In a recent resuscitation of an unconscious elderly woman in ventricular fibrillation, my team observed that upon initiation of cardiopulmonary resuscitation (CPR), she began to make purposeful movements with her arms and legs. During compressions, she batted at the mechanical CPR device and reached for her endotracheal tube. When attempting to place a femoral line, she withdrew to pain from the needle on that side. Through these periods of seemingly purposeful movements, her eyes remained closed and she was not responsive to voice commands. Upon pulse checks, these movements abruptly ceased. Many questions arose during this resuscitation for my team: Should we physically restrain the patient? Should we chemically sedate? What was the level of the patient’s awareness?

Thursday, September 26, 2019

The Power of Mentorship

Image credit: Pexels
Author: Alexandria Gregory, MD
AAEM/RSA Social Media & Publications Committee Chair
Originally published: Common Sense
July/August 2019 

I fell in love with emergency medicine before medical school. Truth be told, I had been hooked on EM since the first time I watched “ER” when I was ten years old. But as I entered college and became pre-med in earnest, I started to wonder if perhaps another specialty might be right for me. That was until I started working as a scribe in the ED. It was there that I fell in love with emergency medicine all over again, and this time for better reasons than I had seen on television. Above all, though, were the people.

Thursday, September 19, 2019

SVI: The Next Step 2 CS

Image credit: Pexels
Author: Haig Aintablian , MD
AAEM/RSA President
Originally published: Common Sense July/August 2019

I did great on my SVI. The day of, I had just gotten a haircut and shaved my beard. My top half was covered by a nicely pressed navy blue suit jacket my mom bought me 4 years ago but that I hadn’t touched since my undergrad graduation. Under the blazer, a white shirt I’d worn twice that week already, and a baby blue tie I’m pretty sure I’ve had since high school. Best of all though, my bottom half was covered with a pair of stereotypical grey Hanes boxers – the type you buy in a 6+1 pack because you get one for free. I sat behind a desk in the middle of my half disastrous room (the side not covered by the camera), prayed an Our Father, and I said what had become my motivational slogan at this point, “**** it, we’re almost done.” I looked great on camera. My upper body displaying a professional, well-groomed student against a clean room backdrop with undergraduate degrees newly hung on the wall. There were no tight pants to hold me back (away rotations made me gain weight like a CHFer off Lasix). Regardless of how I looked on camera, I felt a deep helplessness. During the hardest half year of medical school trying to prove myself on away rotation after away rotation, devoid of family, friends, and proper sleep or nutrition, I was expected to be a robot in front of a video camera for reasons no medical student understood, no administrator could directly answer, and almost no PD would actually care about (let alone watch).