Here at Academic Life in Emergency Medicine, we will be collecting and posting important Twitter pearls in Emergency Medicine and Critical Care from the past week (August 24-31, 2012).
Come join in on the dynamic conversation.
[View the story "Tweet Pearls of the Week 8/24 to 8/31" on Storify ]Tweet Pearls of the Week 8/24 to 8/31 Storified by Javier Benítez · Sun, Sep 02 2012 18:09:54
Worth repeating: Default 1gm vancomycin dose usually not enough. Use 15-20mg/kg (actual body wt) X 1 and adjust for renal function later.Bryan D. Hayes
What is real time (dynamic) imaging?ED Ultrasound Q&A
Type of imaging in which the image is created so many times per second that a cinematic view of the tissues is obtained.ED Ultrasound Q&A
QOD: A child presents w/ a diffuse, maculopapular rash. He recently had a fever of 104 for about 4 days and just got better. Dx?Robert Cooney
aQOD: Roseola or Exanthem Subitum or Sixth's Disease, caused by HHV6; tx with antipyretics and timeRobert Cooney
QOD: What is the most common source(s) of orbital cellulitis? Bonus: common pathogens?Robert Cooney
aQOD: Causes: direct skin inoculation or direct extension from sinuses; pathogens: S. pneumo, H. flu, M. cat, anaerobes, StaphRobert Cooney
What's the most accurate outcome predictor w/ ICH a.Hematoma volume b. rate of growth c.initial exam d.time of onset to presentation (3) INREMedHome
And QoD Hematoma volumes are associated with higher morbidity and mortality; hematoma volume is the most accurate predictor of outcomeEMedHome
What are the signs of increased ICP on CT? Watch Dr. Josh Broder’s Video Pearls in Emergency Radiology: http://cloud.emedhome.com/features/5168.mp4EMedHome
Atropine (dl-hyoscyamine) is found in the Deadly Nightshade (Atropa belladonna) plant, and is a cornerstone in autonomic pharmacology. #AACTBryan D. Hayes
What is the knee?ED Ultrasound Q&A
Region of the curve where the slope changes markedly.ED Ultrasound Q&A
Q: What sign is seen in this gallbladder? What disease process does it suggest? #radiology #MedEd #ultrasound http://pic.twitter.com/DgBR5FVVRadiology Signs
A: Comet tail sign (ring down artifact) of adenomyomatosis http://goo.gl/d9PCT WINNERS @snotdok @BasemBahakeem @camnapper @elwoodiusRadiology Signs
Keep waiting 24 hrs after tPA to give aspirin in ischemic stroke. Early admin has more bleeding and no added benefit. http://www.ncbi.nlm.nih.gov/pubmed/22748820Bryan D. Hayes
What is the near gain control?ED Ultrasound Q&A
This knob regulates the amplification of echoes returning from the near field.ED Ultrasound Q&A
#UCSFtox ocular atropine can last for 3-4 days. Longer than predicted from published 2.5 hr half life.Derrick Lung
Q: Ultrasound in a two month old with vomiting. What sign is seen? Diagnosis? #radiology #ultrasound #MedEd #doctors http://pic.twitter.com/W6kCDUHORadiology Signs
A: Cervix sign (or Antral nipple sign) of Hypertrophic pyloric stenosis http://dlvr.it/23ghvv WINNERS @camnapper @dr_canales & nipple :)Radiology Signs
What are slide pots?ED Ultrasound Q&A
TGC controls can be adjusted in short segments with the use of slide pots. Use for fine tuning.ED Ultrasound Q&A
QOD: A pt presents w/ a swollen tender parotid gland. You suspect suppurative parotitis; What is your management?Robert Cooney
aQOD: hydration, sialogogues (gotta love lemon drops), and antibioticsRobert Cooney
Teaching pearl: "Feedback should deal with decisions and actions, rather than assumed intentions or interpretations." - Dr. Jack EndeBryan D. Hayes
What is the slope rate?ED Ultrasound Q&A
The rate at which echoes are suppressed or amplified as the depth varies.ED Ultrasound Q&A
QOD: A pt presents with refractory hypotension, lethargy, hyponatremia, hyperkalemia, & hypoglycemia. Dx & management?Robert Cooney
aQOD: Adrenal crisis; tx with 100mg of IV hydrocortisone and fluids; don't forget to look for an underlying causeRobert Cooney
Q: Post contrast T1 image. Name 3 features of this lesion that favor ependymoma over astrocytoma. #radiology #MedEd http://pic.twitter.com/NMZITtaPRadiology Signs
A: Well-circumscribed, centrally positioned, dense reasonably homogeneous enhancement http://goo.gl/lHPRv WINNER @camnapper Good job :)Radiology Signs
In hypothermic patients, insulin is ineffective below 30 degrees C.Bryan D. Hayes
Why is proper adjustment of the gain important?ED Ultrasound Q&A
It can vary the strength of the echoes throughout the image and make structures more clearly visibleED Ultrasound Q&A
QOD: In a patient with an inferior STEMI, what does ST elevation greater in III than II suggest?Robert Cooney
aQOD: If you see III elevated more than II in an inferior STEMI, think RCA occlusionRobert Cooney
Univ of Maryland conf pearl of the day: after failed resus's, review all documentation & make sure times of crit actions agree w/each otherAmal Mattu
UMEM pearl of day #2: approx half of malpractice cases turn on the basis of the quality of d/c instructsAmal Mattu
Obese ED patients are frequently underdosed when given antbiotics. And, this study didn't include vancomycin! Aim high. http://www.ncbi.nlm.nih.gov/pubmed/22169576Bryan D. Hayes
Q: Sagittal MRI of the knee. What sign is seen? Diagnosis? #radiology #orthopedics #MRI #MedEd http://pic.twitter.com/QrOGim1fRadiology Signs
A: Celery stalk sign of ACL mucoid degeneration http://dlvr.it/24P8kw Very common - NOT ACL TEAR!! No winner today :(Radiology Signs
Pts given charcoal in ambulance receive it >50 minutes sooner than pts who receive it in the ED. Recommend prehospital admin if appropriate.Bryan D. Hayes
QOD: A pt presents with fever, significant tachycardia, confusion, hypertension, and a CHF pattern on CXR. Suspected dx & tx?Robert Cooney
aQOD: Think thyroid storm in the given case, get labs & start tx with beta-blockers, PTU, & iodine; remember: look for an underlying causeRobert Cooney
Hydrogen cyanide was detected in blood samples from 169 of 285 fire-related deaths (59%) during enclosed-space fires. http://www.ncbi.nlm.nih.gov/pubmed/22882141Bryan D. Hayes
Q: What important sign is seen on this non contrast CT brain? Diagnosis? #radiology #MedEd #medstudent http://pic.twitter.com/bMI5pjcnRadiology Signs
A: Hyperdense MCA sign of hyperacute thrombus http://goo.gl/HYRWM WINNERS @camnapper @AndyNeill @AndrewACNP1 @ahmednagui @yasiralthubaitiRadiology Signs
Although an elevated osmol gap is a potential early surrogate marker of toxic alcohol poisoning, it is neither sensitive nor specific.Bryan D. Hayes
