Good visual aid from the September EP Monthly mag. The article has some deeper info, but in a pinch, remember to look for this:
a.k.a. the Popeye deformity.
There you go.
Note: No indication for FFP and platelets. Both are inactivated by Crotalinae venom.
Tx for significant Crotalinae envenomation in the U.S.
Anaphylaxis to Antivenom:
Submitted by Christina Brown.
Most common venomous snakes in the U.S.
Signs of envenomation:
Submitted by Christina Brown.
came across this handy calculator at GlobalRPH.com.
everyone metabolizes a bit differently, of course, but if you’re curious about ballpark equivalences among the different opiates, check out the link to the calculator.
Aortoenteric fistula: a communication between the aorta and the GI tract
consider in anyone with a GI bleed and a history of aortic surgery.
Can involve any part of the bowel but 75% involve the third part of the duodenum.
Mean time to presentation from surgical date is 32 months, but can run the gamut.
Can be primary (from AAA, but this is rare), but often related to aortic graft
References: MacDougall, L et al. Aorto-enteric fistulas: a cause of gastrointestinal bleeding not to be missed. BJMP. 2010; 3(2): 317. Ranasinghe, W et al. Primary aortoenteric fistulae: the challenges in diagnosis and review of treatment. Ann Vasc Surg. 2011; 25(3): 386; picture
SOME INTERESTING DEFINITIONS:
involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles.
Muscle contraction results in a sudden inspiration and ends with abrupt closure of the glottis, thereby generating the characteristic ‘hic’ sound.
often occur with a frequency of 4 to 60 per minute
The medical term for hiccups (also referred to as ‘hiccoughs’) is singultus, derived from the Latin singult, which means ‘a gasp’ or ‘a sob.’
exact mechanism provoking hiccups remains unknown.
involve unilateral contraction of the left hemidiaphragm in ~80%
pathways involve phrenic and vagus nerves
LESS COMMON CAUSES:
the list of less common, but potential causes is broad, e.g.
Message: if they have other odd or associated symptoms, consider chasing them to a broader differential.
Non-medication (a fun list, with mostly little downside):
|Breathing into bag|
|Ice water gargles|
|Swallowing granulated sugar, hard bread, or peanut butter|
|Drinking from opposite side of glass|
|Catheter or cotton swab stimulation of nasooropharynx|
|Forceable traction on the tongue|
|Biting on a lemon|
|Noxious odors (inhaling ammonia)|
|Pressing on the eyeballs|
|Pulling knees to chest or leaning forward to compress the chest|
first suggestions involve chlorpromazine, reglan, or baclofen.
cyclobenzaprine, haldol are also among the more readily ED available meds on the list. often these meds are not expected to work immediately.
References: uptodate.com; picture
via a 2007 article from Radiologic Technology (found on the imagegently.org site), some contextual info and #’s that might help clarify things in your own mind, and help in risk/benefit discussions with patients:
If you only have 5 minutes, read Table 2 in the article.
If you only have 2 minutes, here are some highlights:
X-rays are high energy, ionizing radiation and will break apart DNA molecules. Light sources and microwaves have much lower energies, which are insufficient to break up molecules.
dose from a typical chest CT examination (5 to 10 mSv) is more than 100 times larger than conventional CXR (0.05 mSv)
CT examination exposures generally are higher than 1 year’s worth of background radiation exposure (~3 mSv).
A CT scan with a dose of 10 mSv has an average cancer induction risk of about 1 in 1000, with half of those cancers being fatal (most are expressed decades after the scan).
overall cancer incidence in a population is ~480/1000.