>EM Reflections – April 2017

Thanks to Dr. Joanna Middleton for her summary

Edited by Dr David Lewis

 

Top tips from this month’s rounds:


Syncopal/Pre-Syncopal Episode – Usually benign, but sometimes serious…….

Red flag symptoms of potentially life-threatening causes of syncope are syncope with exercise, chest pain, dyspnea, severe headachepalpitations, back pain, hematemesis / melena before the syncopal episode. Palpitations before loss of consciousness are a significant predictor of a cardiac cause of syncope. Focal neurologic deficits, diplopia, ataxia, or dysarthria after the syncopal episode.

 

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society


Syncope Risk Scores

San Francisco Syncope Rule

Canadian Syncope Risk Score


ECG in Syncope

CanadiEM – Medical Concept – ECGs in Syncope

Download (PDF, 2.02MB)

 


Subarachnoid hemorrhage can present with syncope…

  • 97% – sudden, severe headache – “worst”
  • 53% – syncope
  • 77% – N/V
  • 35% – meningismus

How To Be A Clinical Rock Star Managing Subarachnoid Hemorrhage

 


 

Abdominal Aorta – Aneurysm vs Dissection

Only 2% of all aortic dissections originate from abdominal aorta. Almost all aortic dissections originate in the thoracic aorta.

The majority of abdominal aortic aneurysms are infrarenal

AAA – A comprehensive review

Download (PDF, 516KB)

 


Management of the Unruptured AAA

  • Symptomatic or asymptomatic
  • How can an unruptured AAA be symptomatic???
    • (rapid expansion of the aortic wall, ischemia from blocking off blood vessels, compression of other structures etc)
  • Symptomatic – admit for repair, regardless aneurysm diameter
  • Asymptomatic
    • <5.5cm – likely outpatient
    • “Very large aneurysm” (>6cm) – likely admit for repair

 

Transfers to and from Major Emergency Departments

  • Emergency transfers from referring sites for diagnostic imaging are potentially high risk
  • Adverse events have been reported in the medical literature for this group of patients
  • A detailed handover between referral and receiving site will reduce risk
  • Patient stability must be assessed prior to transfer, on arrival at receiving site and prior to return to referral site.
  • The results of the diagnostic imaging should be taken into context with the patient’s condition prior to release for return to referral site.

Download (PDF, 293KB)

 


 

Hyponatremia – How low is too low?

 

  • All patients with severe (< 120)
  • Any patient that is symptomatic from the hyponatremia

LIFL – Hyponatremia – Diagnosis and Management

 

For the budding critical care physiologist – Deranged Physiology – Hyponatremia

 

 

 

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