Sunday, January 31, 2016

TXA Literature Review

Author: Alexandra Murray, DO PGY1
Mercy St. Vincent Medical Center Emergency Medicine

Originally Published: Modern Resident - December-January 2016

What is tranexamic acid (TXA)?
When the body experiences vascular injury, the hemostatic system tries to maintain circulation by balancing the formation and degradation of blood clots. In response to severe blood loss, this balance is challenged and hyper-fibrinolysis can occur. The conversion of plasminogen to plasmin plays a large role in fibrin binding and degradation. Tranexamic acid is a synthetic derivative of lysine that reversibly blocks binding sites on plasminogen and inhibits fibrinolysis.[1] TXA has been approved by the FDA since 1986 as an antifibrinolytic and has been marketed for menorrhagia (Lysteda) and dental hemorrhage in hemophiliacs (Cyklokapron).[2,3] More recently, TXA has been investigated as a treatment for posttraumatic hemorrhage, postpartum hemorrhage and prevention of surgical blood loss.

Sunday, January 24, 2016

Diphenhydramine Overdose in the ED

Image Credit: Flickr Andrew Ranta
Author: Kaylinn Dokken, OMSIV
Western University of Health Sciences

You are just at the beginning of your shift when paramedics call in and notify you that they are bringing in a 35 year old female who reports that she took 3,000 mg of diphenhydramine in a suicide attempt. Her BP is 145/80, her pulse is 160 beats per minute (bpm) with sinus tachycardia on the monitor, and her respiratory rate is 24 breaths per minute. Upon presentation, the patient is disoriented, continuously writhing, and having intermittent myoclonic jerks. An initial EKG is obtained and is shown below.

Sunday, January 10, 2016

Expanding the Differential: What Else Can an Elevated Troponin Signify?

Author: Shyam Sivasankar, MD
Stanford-Kaiser Emergency Medicine

Originally Published: Modern Resident, December-January 2015

We often underestimate the utility of modern laboratory technology—we become shortsighted and we forget that a lab value can tell us more than what we are naturally used to it representing. One such lab value is cardiac troponin.

Instinctively, we assume that an elevated troponin is a sign of a myocardial infarction (MI), but that is not always the case. Troponin is released by cardiac muscle fibers in the setting of irreversible cell injury.

Occasionally, we can be fooled into thinking that all chest pain with an elevated troponin is a definitive diagnosis of MI, but other life-threatening causes of chest pain such as pulmonary embolism (PE) or aortic dissection can also present with an elevated troponin. The ‘troponin leak’ from PE results from right-sided heart strain and from direct myocardial injury in dissection. Elevated troponin can also be seen in pericarditis (which can also present with ST segment changes), myocarditis, blunt chest trauma and arrhythmias. Patients who have suffered from cardiac arrest and undergone CPR can also have elevated troponin levels.

Sunday, January 3, 2016

Clonidine Toxicity: A Brief Review

Image Credit: Flickr Pranjal Mahna
Author: Matt Rosen, MSIV
Georgetown School of Medicine

This post was peer reviewed.
Click to learn more.

Clonidine was once a popular antihypertensive agent, and while its use as a primary blood pressure agent has declined, it continues to have a role in hypertension management for some patients. Clonidine is also being used in other applications such as treatment of migraines, treatment of vasomotor symptoms associated with menopause or withdrawal, and in a number of pediatric applications such as pre-anesthesia, postoperative pain management, and panic/anxiety disorders.[1, 5]

Friday, January 1, 2016

Blog Staff, Reviewers, & Mentors

Thank you to our 2016-2017 peer review & editorial team!

AAEM/RSA Leadership:

Mary Haas, MD
AAEM/RSA President
University of Michigan

Amy Ho, MD
AAEM/RSA Vice President
University of Chicago

Phil Dixon, MD
AAEM/RSA Secretary-Treasurer
University of Mississippi Medical Center

Victoria Weston, MD
AAEM/RSA Immediate Past President
Northwestern University

AAEM/RSA Blog Leadership:

Mike Wilk, MD
Blog Editor-in-Chief
Publications Committee Co-Chair
Brown University

Jake Toy, MS4
Copy Editor
Arrowhead Regional Medical Center

Greg Wanner, DO
Blog Advisor
Past Editor-in-Chief
Thomas Jefferson University Hospital

Janet Wilson, CAE
Executive Director, AAEM/RSA

Laura Burns, MA

Communications Manager, AAEM

Madeleine Hanan, MSM
Program Manager, AAEM/RSA

Publications Mentors:

Attending physicians or fellows who have agreed to help authors and reviewers learn about and navigate the publications process. Interested attendings/fellows can contact

Michael Epter, MD
Laleh Gharahbaghian, MD
Nikita Joshi, MD
Arayel Osborne, MD
Andrew Phillips, MD MEd
Loice Swisher, MD

Peer Reviewers:

Mary Haas, MD
Amy Ho, MD
Phil Dixon, MD
Victoria Weston, MD
Ashely Alker, MD
Nathan Haas, MD
Shana Nelson, DO
Melanie Pollack, DO
Tiffany Walker Sigal, MD
Mike Wilk, MD
Stephanie Cihlar
Daniel Leiva, DO
Megan Litzau, MD
Ashley Grigsby, MD
Jennifer Reink
Joshua Symes
Christine Au
Niklas Eriksson
Alexandria Gregory
Michelle Mitchell
Scott Bland
Thomas Hull