From: DailyQuestion@...
Date: May 25, 2009 7:11:50 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What solvent, when inhaled, can lead to high carbon monoxide (CO) levels and toxicity?

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The Answer is:

Methylene chloride, a solvent found in paint remover and aerosol propellants, is
converted in the body to CO after inhalational exposure and can produce CO poisoning (EM Clin NA;22:985).



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From: DailyQuestion@...
Date: May 27, 2009 8:08:43 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What exactly is a molar pregnancy?

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The Answer is:

Molar pregnancies encompass a spectrum of gestational diseases characterized by proliferation of chorionic villi. Moles can be partial or complete and carry risk of persistent gestational trophoblastic disease (JEM, In Press, online 5/18/09)..


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From: DailyQuestion@...
Date: June 4, 2009 7:10:53 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Vomiting can occur when acetaminophen overdose patients are being treated with oral acetylcysteine.  How should the acetylcysteine regimen be adjusted if vomiting occurs?

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The Answer is:

Patients treated with oral acetylcysteine should be monitored for vomiting and the dose of acetylcysteine should be repeated if the patient vomits within 60 minutes after any dose (NEJM 2008;359:285).


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From: DailyQuestion@...
Date: June 5, 2009 7:10:53 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Contrast-medium-induced nephropathy is usually transient.  When does the serum creatinine level peak and when does it return to baseline?

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The Answer is:

Contrast-medium-induced nephropathy is usually transient, with serum creatinine levels peaking at 3 days after administration of the medium and returning to baseline within 10 days after administration (NEJM;354:379).


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From: DailyQuestion@...
Date: June 3, 2009 8:08:10 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Thrombotic occlusion of the IVC is a well-recognized complication of IVC filter placement that occurs in  up to 11% of patients. What are the causes of an obstructing IVC filter thrombosis?

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The Answer is:

Efficient thrombi trapping by the filter, thrombogenic potential of the device, and intracaval extension of a proximal DVT is among the potential causes of an obstructing IVC filter thrombosis (Ann of EM, 8/08, pg. 104).


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From: DailyQuestion@...
Date: June 6, 2009 7:10:59 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What is primary biliary cirrhosis?  What is the diagnostic hallmark?

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The Answer is:

PBC is a chronic cholestatic liver disease of autoimmune etiology that affects predominantly middle-aged women. Antimitochondrial antibodies are the diagnostic hallmarks of PBC (Mayo Clin Proc, 6/09, pg. 551).


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From: DailyQuestion@...
Date: June 2, 2009 7:11:31 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Which one of the following events is the most common cause of postpartum deaths:  Pulmonary embolism, Sepsis, Severe hemorrhage, or Suicide?

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The Answer is:

Suicide.  As an example, a 1994-1996 study conducted in the UK showed that 10% of maternal deaths were due to suicide, the largest single cause of postpartum deaths (NEJM, Vol. 359, pg. 509).


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From: DailyQuestion@...
Date: June 1, 2009 7:11:11 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Management of an acute adrenal crisis consists of immediate intravenous administration of how much hydrocortisone?

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The Answer is:

Management of an acute adrenal crisis consists of immediate IV administration of 100 mg of hydrocortisone, followed by 100 - 200 mg every 24 hours and a continuous infusion of larger volumes of physiologic saline solution (NEJM, 5/28/09, pg. 2328).


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From: DailyQuestion@...
Date: May 29, 2009 7:13:00 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What is the most common cause of an inappropriate shock of an implantable cardioverter defibrillator?

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The Answer is:

The most common causes of inappropriate shocks are supraventricular tachycardias, including atrial fibrillation/flutter; these rhythms may require rate control, anticoagulation, or adjustments in ICD sensing thresholds (Am J EM, 9/07, pg. 812) .


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From: DailyQuestion@...
Date: May 31, 2009 7:11:08 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

At what gestational age does the gravid uterus reach a size the will compromise aortocaval blood flow and cardiac output?

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The Answer is:

At a gestation age of 20 weeks and beyond, the pregnant uterus can press against the IVC and aorta, impeding venous return (Circulation, Vol. 112, pg. IV-150).


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From: DailyQuestion@...
Date: June 8, 2009 8:08:20 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What hematologic disease state can lead to higher endogenous CO-Hgb levels?

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The Answer is:

In hemolytic anemia, CO-Hgb may increase to 3% to 4% (Emerg Med Clin NA; Vol. 22:985).


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From: DailyQuestion@...
Date: June 10, 2009 5:08:28 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

The primary fetal risks associated with high-dose radiation exposure from imaging studies are growth restriction, microcephaly, and developmental disabilities. When is the fetus vulnerable?

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The Answer is:

The most vulnerable period is 8-15 menstrual weeks of gestation with minimal risk before 8 weeks and after 25 weeks (MMWR, April 10, 2009 ).


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From: DailyQuestion@...
Date: June 14, 2009 4:11:42 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Emphasis in reperfusion therapy for acute MI has shifted from fibrinolysis to percutaneous coronary intervention.  What portion of AMI patients in the US present to hospitals without ready access to PCI?

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The Answer is:

60% - 70% of AMI patients in the US present to hospitals without ready access to PCI (Annals of EM, 6/09, pg. 742).


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From: DailyQuestion@...
Date: June 13, 2009 4:11:38 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

For how long can heroin be detected in the urine following last use? What about cocaine?

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The Answer is:

Heroin can be detected up to 48 hours following last use; Cocaine metabolites can be detected up to 2-4 days after last use (Mayo Clin Proc, 1/07, pg. 66).


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From: DailyQuestion@...
Date: June 15, 2009 4:11:42 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What is the most commonly identified cause of pneumonia in HIV-infected patients?

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The Answer is:

Currently, Streptococcus pneumoniae is the most commonly identified cause of pneumonia in HIV-infected patients (Ann of EM, September, 2008, pg. 274).


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From: DailyQuestion@...
Date: June 9, 2009 4:11:04 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

A patient presents to the ED with myxedema coma.  What two medications should be administered intravenously in the ED?

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The Answer is:

Myxedema coma, a potentially lethal complication of hypothyroidism, is treated with levothyroxine IV.  An IV glucocorticoid is also recommended until adrenal insufficiency has been excluded (Journal of Emergency Medicine, Vol. 28, pg. 203).


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From: DailyQuestion@...
Date: June 16, 2009 4:11:48 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Acute septic arthritis involving 2 or more joints should raise a suspicion of what condition?

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The Answer is:

Acute septic arthritis involving 2 or more joints should raise a suspicion of Infective Endocarditis (Mayo Clin Proc, May, 2007, pg. 615).


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From: DailyQuestion@...
Date: June 12, 2009 4:11:35 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Transverse myelitis may follow a recent infection.  Which organsim is the only known bacterial trigger associated with transverse myelitis?

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The Answer is:

Mycoplasma is the only known bacterial trigger of transverse myelitis (Annals of Emergency Medicine, Vol. 46, pg. 256).


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From: DailyQuestion@...
Date: May 30, 2009 4:11:00 AM PDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Fluid requirements for the initial resuscitation of patients with septic shock are commonly large.  How much crystalloid is typically required in the first 24 hours?

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The Answer is:

Up to 10 liters of crystalloids are required in the first 24 hours of resuscitation of septic shock (Journal of Emergency Medicine, Vol. 31, pg. 188).


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From: DailyQuestion@...
Date: June 19, 2009 7:11:46 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

If rtPA is to be used for treatment of an acute pulmonary embolism, what is the dose?  Is heparin to be used?

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The Answer is:

If rtPA is to be used for a PE, a single dose of 100 mg over 2 h followed by unfractionated heparin is suggested (JEM, In Press, online 06 April 2009).


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From: DailyQuestion@...
Date: May 26, 2009 7:11:47 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

When performing a lumbar puncture, reinsertion of the stylet before removal of the needle has been shown to reduce the incidence of post-LP headache.  What is the explanation for this?

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The Answer is:

It is thought that a strand of arachnoid enters the needle along with the outflowing CSF; if the stylet is not replaced, the strand is threaded back through the dura during needle removal, producing prolonged CSF leakage  (JAMA, Vol. 296, pg. 2016).


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From: DailyQuestion@...
Date: May 12, 2009 7:11:58 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

Ciguatera fish poisoning results from eating predatory ocean fish contaminated with ciguatoxins. Neurologic symptoms characteristically includes reversal of hot and cold sensation. What is the management of neurologic symptoms?

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The Answer is:

Intravenous mannitol has been the mainstay of management of neurologic symptoms (MMWR, March 27, 2009).


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From: DailyQuestion@...
Date: May 21, 2009 7:11:21 AM EDT
To: glennskow@...
Subject: EMedHome Question of the Day

The EMedHome Question of the Day is:

What factors predispose individuals to STEMI rather than UA or NSTEMI?

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The Answer is:

Factors predisposing to STEMI rather than UA/NSTEMI are currently unknown; patients with STEMI tend to be younger, with a higher propensity of single-vessel CAD, and with less advanced heart disease than UA/NSTEMI patients (Am J EM, 2/08, pg. 212).


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