Podcast # 366: Ehlers Danlos
Author: Gretchen Hinson, MD.
- Heritable mutation in collagen synthesis and expression commonly resulting in joint hyperextension and skin elasticity.
- Vascular type can result in aneurysm formation and rupture in young patients.
- Patients are also at risk for spontaneous bowel rupture.
- Pregnant women can present with uterine rupture.
Byers PH, Murray ML (2012). “Heritable collagen disorders: the paradigm of Ehlers?Danlos syndrome”. Journal of Investigative Dermatology. 132 (E1): E6?11.
Pepin MG, Byers PH. Ehlers-Danlos Syndrome Type IV. In: Pagon RA, Bird TD, Dolan CR, et al., eds. GeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-.
Yoneda, A., Okada, K., Okubo, H., Matsuo, M., Kishikawa, H., Naing, B. T., ? Shimada, T. (2014). Spontaneous Colon Perforations Associated with a Vascular Type of Ehlers-Danlos Syndrome. Case Reports in Gastroenterology, 8(2), 175?181. http://doi.org/10.1159/000363373
Author: Sam Killian, MD
- Recent study examining fasting and adverse events during procedural sedation found no association between fasting duration and any type of adverse event.
- Of the 6,183 children in the study, about 6 vomited during the procedure, and about 300 vomited recently after the procedure, and there were no episodes of aspiration.
Bhatt, M, et al. (2018). Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children. JAMA Pediatrics, doi: 10.1001/jamapediatrics.2018.0830. [Epub ahead of print]
Author: Sam Killian, MD
- Insufficient sleep and disrupted circadian rhythms are a major health problem today
- Millions of dollars, thousands of deaths, and millions of injuries are related to sleep deprivation every year
- 56 billion dollars – 24,000 deaths – 2.5 million disabiling injuries related to a sleep-type deprivation
- Exxon valdez, challanger, chyrnobel linked to sleep deprivation- at least partially
- Data has shown that in the Spring (when people lose an hour of sleep) there were 8% more traffic accidents on the Monday immediately after daylight savings. Conversely, in the Fall (when people gain an hour of sleep), there were 8% fewer traffic accidents on the Monday immediately after daylight savings.
- Studies have also shown an increased risk of myocardial infarction in Spring immediately after daylight savings, and a decreased risk of myocardial infarction in the Fall immediately after daylight savings.
Corren S. Traffic Accidents and Daylight Saving Time. New England Journal of Medicine. 1996;335(5):355-357. doi:10.1056/nejm199608013350517
Janszky I, Ljung R. Shifts to and from Daylight Saving Time and Incidence of Myocardial Infarction. New England Journal of Medicine. 2008;359(18):1966-1968. doi:10.1056/nejmc0807104.
Author: Dylan Luyten, M.D.
- Hypoglycemia is very common in type 2 diabetics, and is often caused by insulin overdose or missed meals. Knowing the peak time of action for common diabetes medications can help inform treatment and disposition.
- Regular insulin’s action peaks around 60 minutes. By the time most of these patients present to the ED, the drug has had most of its effect.
- Lantis’ action does not peak, and will continue to exert its effect for 12 or more hours.
- Levamir has a peak around 6-8 hours.
- Metformin sensitizes tissues to insulin, so it cannot cause hypoglycemia alone.
- Glipizides have half-lives over 12 hours and work by increasing insulin release by the pancreas. Hypoglycemia in a patient taking a glipizide usually indicates there is another medical issue interfering with clearance
Author: Rachel Beham, PharmD, Advanced Clinical Pharmacist – Emergency Medicine
- Tetanus Ig is indicated in those who have no or unknown tetanus vaccination history who present with contaminated cuts that or dirty puncture wounds
- The tetanus vaccine is a 5 shot series (DTAP) for children, TDAP is used for adults
- There is no harm is receiving the TDAP more than once if vaccination history is unknown
Author: Pete Bakes, M.D.
- One of the roles of the ER provider is to discharge patients only after life-threatening conditions have been ruled out. However, some patients that are discharged from the ED die within days of their discharge. One recent study sought to investigate the factors and diagnoses associated with death within 7 days of discharge.
- This study was a retrospective study in 10 million medicare recipients that presented to the ER over 10 years. They excluded palliative, hospice and SNF patients.
- 0.12% of these patients died within 7 days of ER discharge. Signs and symptoms such as altered mental status, general malaise and fatigue, and nonspecific dyspnea had relative risks of 3-5 for death following discharge.
- Think carefully before discharge in patients with the signs/symptoms above.
References: Obermeyer Ziad, Cohn Brent, Wilson Michael, JenaAnupam B, Cutler David M. Early death after discharge from emergency departments: analysis of national US insurance claims data BMJ 2017;356 :j239