Blog Archives

Tendinopathy and fluoroquinolones

8/15/2018

The risk of tendinopathy is increased in patients taking fluoroquinolones (FQs) along with steroids. Watch out for this combination in COPD patients.

FQs should be used cautiously in patients with risk factors associated with tendinitis, such as advanced age, history of tendon rupture, corticosteroid use, and/or acute or chronic renal dysfunction. Tendinitis can be misdiagnosed as a gouty flare, infection, or venous thrombosis (leg region involvement). Since Achilles tendinitis can be debilitating and
may lead to rupture, clinicians may need to monitor changes in gait and for symptoms suggestive of tendinopathy in patients on FQ therapy.

Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921747/pdf/jcad_3_4_49.pdf

Scaphoid fractures

8/8/2018

Scaphoid fractures

Carpal fractures account for approximately 5% of all fractures and 18 percent of hand fractures, and scaphoid fractures are the most common carpal fracture. Scaphoid fractures account for 10% of all hand fractures and 60-70% of all carpal fractures. Scaphoid fractures are among the most common upper extremity injuries. They frequently occur following a fall onto an outstretched hand. Plain radiographs taken soon after the injury may not reveal a fracture, but the clinician should assume one is present until definitive proof otherwise is obtained.

Sodium bicarbonate

8/7/2018

■ Taiwan: 7% NaHCO3 (e.g. Rolikan) = 16.7 mEq/20 mL/amp.
■ USA: 8.4% NaHCO3 = 50 mEq/50 mL/amp.
■ Usual dose of NaHCO3 = 1 mEq/kg stat followed by 0.5 mEq/kg as needed.
■ 50 mEq of NaHCO3 = 1 amp of 8.4% 50mL = 3 amp of 7% 20mL.

Wide QRS tachycardia

8/7/2018

Mimics of VT
1. Hyperkalemia
- HR usually < 120 bpm
2. Sodium channel blocker toxicity
- often very wide QRS > 200 ms
3. Accelerated Idioventricular Rhythm (AIVR)
- often seen post-lytics for STEMI

Accelerated Idioventricular Rhythm (AIVR):

This is a reperfusion rhythm often seen post-lytics for STEMI; Think of “slow VT”. The treatment is observation, not medication.

Pitfall: Mistaking AIVR (post-lytics for STEMI) for VT and treating with lidocaine may cause cardiovascular collapse.

Reference:
https://emergencymedicinecases.com/tachydysrhythmias/

ATLS 10th Ed Update

8/5/2018

Some new changes to ATLS 10th Ed:

■ RSI (rapid sequence intubation) --> DAI (drug assisted intubation).
■ Needle decompression of pneumothorax:
# Adults --> 4th/5th ICS anterior to midaxillary line.
# Pediatric --> 2nd ICS midclavicular line.
■ Chest tube size: 28-32F (pig-tail only for small pneumothorax).
■ CXR reading mnemonic: DRSABCDE.
■ Fluid resuscitation: 1L warm crystalloid, 18G peripheral access x 2.
■ Massive transfusion: > 10U in 24h or > 4U in 1h. (1U in USA = 2U in Taiwan).
■ Tranexamic acid 1g over 10 min stat and 1g over 8h given within 3h of trauma.
■ Blunt aortic injury: targets HR = 80 MAP = 60-70 mmHg.
■ Blunt cardiac injury: emphasize ECG monitor, Tn-I inconclusive.
■Pelvic fracture without hemoperitoneum: both preperitoneal packing and TAE are acceptable.
■ High-riding prostate: not equal to urethral rupture.
■ No more DRE to detect high-riding prostate. Note that DRE still indicated in selected patients in order to detect anal sphincter tone, bowel wall integrity, and bony fragments.
■ Traumatic brain injury:
# HPI: should inform neurosurgeon if patient under anticoagulation.
# GCS: "to speech" --> "to sound".
# GCS: "to pain" --> "to pressure".
# GCS: can document as "NT (non-testable)".
# Prolonged hyperventilation with PCO2 <25mmHg not recommended.
# If 50-69Y: keep SBP ≥ 100mmHg.
# If 15-49Y or >70Y: keep SBP ≥ 110mmHg.
# Caution, high-dose propofol can produce significant morbidity.
# Mannitol 0.25-1 g/Kg to control ICP, avoid arterial hypotension.
# High-dose barbiturate to control refractory IICP, avoid arterial hypotension.
# Phenytoin can reduce incidence of early post-traumatic seizure (within 7 days).
■ Spine: "spinal immobilization" --> "spinal motion restriction".
■ Burns > 20% TBSA: IVF = 2ml LR x KG x % TBSA burn, avoid fluid boluses unless the patient is hypotensive (pediatric: 3ml x KG x % TBSA).
■ Hypovolemia resuscitation in children:
# 20 ml/kg bolus crystalloid.
# 10-20 ml/kg of PRBC.
# 10-20 ml/kg of FFP or platelet.
■ Trauma in Pregnancy: If vaginal fluid pH > 4.5 --> amniotic fluid leak (+).

#FOAMED #Trauma #ATLS

Read more at...
https://www.slideshare.net/sunny_8162/atls-10th-edition-compendium-of-change

Tendinopathy and fluoroquinolones

Scaphoid fractures

Scaphoid fractures

Sodium bicarbonate

Wide QRS tachycardia

Mimics of VT1. Hyperkalemia - HR usually < 120 bpm2. Sodium channel blocker toxicity - often very wide QRS > 200 ms​3. Accelerated Idioventricular Rhythm (AIVR) - often seen post-lytics for STEMI

ATLS 10th Ed Update

AuthorTwitter: @jackcfchong[email protected]

Archives

Mimics of VT
1. Hyperkalemia
- HR usually < 120 bpm
2. Sodium channel blocker toxicity
- often very wide QRS > 200 ms
3. Accelerated Idioventricular Rhythm (AIVR)
- often seen post-lytics for STEMI

Author
Twitter: @jackcfchong
[email protected]