Amal Mattu's ECG Case of the Week: April 28, 2014

52 Articles 2014

Here's my attempt at 52 articles in 52 weeks.  Our residency will be reading all of these over the next year.  Disclaimer: subject to change.

Airway	Preoxygenation and prevention of desaturation during emergency airway management.	Weingart SD	2012	Ann Emerg Med	PubMed
Airway	The importance of first pass success when performing orotracheal intubation in the emergency department.	Sakles JC	2013	Acad Emerg Med	PubMed
Airway	Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?	Burton JH	2006	Acad Emerg Med	PubMed

Brugada Type II

30M w/o PMH p/w intermittent CP and dizziness w/o syncope x 1 year.

NOAC Reversal

Ok, we all know warfarin sucks.  Patients hate it because it has to be monitored, and if they eat too many collard greens or you prescribe bactrim or cipro they're going to bleed and die.  Invariably, we've all had the patient with hematuria and an INR of 10, but totally stable and with a normal hematocrit.  You consult "the chart" on uptodate and end up more confused.  So, you make something up...um...let's stop taking the warfarin for the next two days, and decrease your dose from 5 mg to 4 mg...and, um...here's 2.5 mg of vitamin K...now, go check in at your coumadin clinic...

Phlegmasia Cerulea Dolens

Sudden onset painful leg that became swollen within 15 minutes.

Osteomyelitis

53M s/p TMA p/w new ulcer.  Elevated inflammatory markers and clear cortical involvement on XR (although not called by radiology); MR confirmed oseteo.  Findings suggestive of OM on radiography include cortical erosion, periosteal reaction, mixed lucency, and sclerosis; but may not be evident for up to 2 weeks into the infection.

Lane's Top Ten

I can't claim credit for this, but Lane Blankenship recently gave his Senior Grand Rounds, and it was excellent!  Here are his top ten articles:

Free Air

60M w/o PMH p/w sudden onset abd pain several hours earlier, rigid abd, found to have free air on upright.  Perfed dudenoal ulcer found on ex-lap.

Spine Sign

40F c h/o CHF p/w SOB and productive cough.  Radiology report made no mention of focal consolidation.  The vertebral bodies should become more lucent the more inferior they are, but you can clearly see they become more opaque in this lateral view - a finding called "the spine sign."  This is consistent with a focal consolidation.

Transfusion Strategies in UGIB

Villanueva C, et al.  Transfusion Strategies for Acute Upper Gastrointestinal Bleeding.  2013 Jan 3;368(1):11-21.
Recently, I presented the landmark article for promoting a restrictive transfusion strategy in upper GI bleeding (UGIB) at our journal club.  I spent a fair amount of time researching the background to this study.  Suffice it to say, there's been a lot of nerds manufacturing non-evidenced based guidelines for decades regarding this issue.  They usually met in Italy, so I can understand the draw to convene.  This study aimed to set the record straight on transfusion strategy for undifferentiated UGIB.