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






Questions
  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
Committee

INTRODUCTION
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?