Author: Michael Hunt, MD
- Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective
- Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive and 97.1% specific
- Curvilinear probe may be preferable as it provides a larger field of view
Editor’s Note: rather than explain what you’re looking for… just go here
Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2018 Dec;72(6):627-636. doi: 10.1016/j.annemergmed.2018.06.024. Epub 2018 Aug 14. PubMed PMID: 30119943.
Summarized and edited by Erik Verzemnieks, MD
Author: Jared Scott, MD
- CXR is 40-90% sensitive for detecting pneumonia when compared to CT
- Patients with a high degree of suspicion for pneumonia may still warrant treatment despite a negative CXR
Self WH, Courtney DM, McNaughton CD, Wunderink RG, Kline JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013 Feb;31(2):401-5. doi: 10.1016/j.ajem.2012.08.041. Epub 2012 Oct 18. PubMed PMID: 23083885; PubMed Central PMCID: PMC3556231.
Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD
Author: Gretchen Hinson, MD
- Diagnosis can be difficult and often delayed
- Asymmetric breath sounds, choking, stridor may be present, but children also present asymptomatically
- Peak incidence around one to two years of age
- Hot dogs, nuts, popcorn – round and smooth objects are most commonly aspirated
Green SS. Ingested and Aspirated Foreign Bodies. Pediatr Rev. 2015 Oct;36(10):430-6. doi: 10.1542/pir.36-10-430. Review. PubMed PMID: 26430203.
Sink JR, Kitsko DJ, Georg MW, Winger DG, Simons JP. Predictors of Foreign Body Aspiration in Children. Otolaryngol Head Neck Surg. 2016 Sep;155(3):501-7. doi: 10.1177/0194599816644410. Epub 2016 Apr 12. PubMed PMID: 27071446.
Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD
Check out this episode!
Author: Gretchen Hinson, MD
- Legionnaires disease refers to a severe pneumonia caused by Legionella pneumophilia and occurs typically at the extremes of age
- Associated gastrointestinal symptoms (nausea/vomiting/diarrhea) may be present
- Hyponatremia is a common laboratory finding
- Legionella urinary antigen can be a convenient test to identify the infection
- Treatment is with fluoroquinolones, macrolides and/or tetracyclines
Pierre DM, Baron J, Yu VL, Stout JE. Diagnostic testing for Legionnaires’ disease. Annals of Clinical Microbiology and Antimicrobials. 2017;16:59. doi:10.1186/s12941-017-0229-6.
Cunha BA, Cunha CB. Legionnaire’s Disease and its Mimics: A Clinical Perspective. Infect Dis Clin North Am. 2017 Mar;31(1):95-109. doi: 10.1016/j.idc.2016.10.008. Review.
Author: Chris Holmes, MD
- Epidemiology: 80% male, ages 1-4 at greatest risk, African-American > Caucasian.
- Freshwater and ocean water may have more bacteria than pool water.
- Salt water is hyperosmolar, which theoretically increases risk of pulmonary edema.
- Greatest physiologic insult is from hypoxia secondary to fluid aspiration or laryngeal spasm. Patient survival is related to presentation on arrival.
- Workup includes CXR and ABG; consider C-spine immobilization/imaging when cervical injury is strongly suspected (i.e. diving injury).
- Treatment consists of supplemental oxygen therapy. Consider CPAP or intubation.
Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012. 366(22):2102-10. doi: 10.1056/NEJMra1013317.
Schmidt A, Sempsrott J. Drowning In The Adult Population: Emergency Department Resuscitation And Treatment. Emerg Med Pract. 2015. 17(5):1-18.
Author: John Winkler, MD
- Singed nasal hairs, soot around mouth, hoarse voice, drooling, and burns to head/face are signs suggestive of inhalation injury.
- Early intubation is critical for these patients as the airway changes rapidly.
- With inhalation injuries, the upper airway is burned while the lower airway is damaged by inhaled chemicals in the soot and can cause ARDS.
- Carbon monoxide (CO) and cyanide (CN) poisoning can occur with inhalation injuries.
- Treatment for CO poisoning is 100% oxygen and possible hyperbarics. Treatment for CN poisoning is cyanocobalamin.
Rehberg S, Maybauer MO, Enkhbaatar P, et al. Pathophysiology, management and treatment of smoke inhalation injury. Expert Rev Respir Med 2009; 3:283.
Woodson CL. Diagnosis and treatment of inhalation injury. In: Total Burn Care, 4 ed, Herndon DN (Ed), 2009.
Author: Sam Killian, MD
- Being exposed to E-cigarette vapor may increase risk of pneumonia.
- Recent study has shown e-cigarette vapor increases quantities of Platelet-activating-receptor factor in epithelial cells, which may aid pneumococcal bacteria in entering pneumocytes.
Miyashita L, et al. (2018). E-cigarette vapour enhances pneumococcal adherence to airway epithelial cells. The European Respiratory Journal. 7;51(2).
Author: Don Stader, M.D.
- Pulmonary embolism is one of the leading causes of maternal mortality.
- There is disagreement among different medical societies about the value of D-dimer as a screening modality. If you use it, consider the rational D-dimer approach whereby you add 250 to your cut-off for every trimester.
- A useful screening modality is an ultrasound of bilateral lower extremities looking for DVT.
- Keep in mind, both a V/Q scan and CT scan have a significant amount of radiation. CTA is probably the right diagnostic test (less radiation than CT w&w/o).
- Always use the shared decision-making model and clinical acumen to choose your tests.
Leung AN, et. al. (2011). An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. American Journal of Respiratory and Critical Care Medicine. 184(10):1200-8
Polak JF, Wilkinson DL. (1991). Ultrasonographic diagnosis of symptomatic deep venous thrombosis in pregnancy. American Journal of Obstetrics and Gynecology. 165(3):625-9.
Sachs BP, et. al. (1987). Maternal mortality in Massachusetts. Trends and prevention. New England Journal of Medicine. 316(11):667-72.
Check out this episode!
Author: Sam Killian, M.D.
- Difficulty with bag valve mask (BVM) ventilation can be addressed using the MOANS mnemonic.
- Mask seal, Obesity/obstruction, Age, No teeth, Sleep apnea.
- Often BVM difficulty can be addressed by an extra set of hands.
Author: Dave Rosenberg, M.D.
- Poiseuille’s Law addresses the flow of a fluid through a tube.
- Many common ED presentations involve alterations in flow: asthma, MI, ischemic stroke, etc.
- According to the law, flow increases with the 4th power of the radius. That is to say, doubling the radius of the tube will increase the flow by 16x.
- Therefore, in situations that require re-opening of an anatomic tube (artery, airway), small changes in the size of the opening will result in dramatic effects.