FOAMcastini - Undifferentiated Agitation and Cured Pork

#smaccDUB day 2

Dr. Reuben Strayer - “Disruption, Danger, and Droperidol: Emergency Management of the Agitated Patient."  

Dr. Strayer presented a brilliant talk on dealing with the quintessential Emergency Medicine patient - the undifferentiated acutely agitated patient. These patients are high risk and require emergent stabilization and resuscitation.

Dr. Haney Mallemat - "The PEA Paradox"

The typical way we think about PEA, the "H's and T's," is overly complicated. Further, we are horrendous at pulse palpation (see this for more), and so what we think is PEA may not actually be PEA.  Dr. Mallemat proposed QRS duration as one way to think about PEA, although this has limitations.

Dr. Michele Dominico - "How Usual Resuscitative Maneuvers Can Kill Paediatric Cardiac Patients"

Interventions we jump to in sick patients - oxygenation, ventilation, vasopressors - these can kill pediatric patients with cardiac pathology. She gave examples of some high yield pearls in these already terrifying patients.

EM Literature update by Drs. Ashley Shreves and Ryan Radecki

• Antibiotics for uncomplicated diverticulitis? May not be necessary
• Antibiotics for appendicitis? Maybe an option for some, but it may just be delaying an appendectomy.
• Tamsulosin for ureteral stones? Not necessarily indicated unless there are large (>5mm), distal stones.

Interesting and Ridiculous Research Pearls from Drs. Ashley Shreves and Ryan Radecki

• Perception of dyspnea and pulmonary function tests change with stress - and rollercoaster rides.  Rietveld S, van Beest I. Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception. Behaviour research and therapy. 45(5):977-87. 2007. [pubmed]
• Cured pork for epistaxis? Possibly. Researchers will try everything, especially if it involves bacon. Humphreys I, Saraiya S, Belenky W, Dworkin J. Nasal packing with strips of cured pork as treatment for uncontrollable epistaxis in a patient with Glanzmann thrombasthenia. The Annals of otology, rhinology, and laryngology. 120(11):732-6. 2011. [pubmed]