Which anti-epileptic is most likely to cause hyponatremia?
A. Carbamazepine
B. Dilantin
C. Valproic Acid
D. Lacosamide
E. Levetiracetam
Answer is A - Carbamazepine or Tegretol
Bonus Question: What is the first line management in Trigeminal Neuralgia?
Answer: Carbamazepine or Tegretol
Dr. Anil Reddy discusses status epilepticus in the Emergency Department.
A 40 year old man presents via ambulance after he was found stumbling around a park on a hot summer day. He is mumbling, not responding to questions appropriately, and very disoriented. His skin is dry and hot to touch. Rectal temperature is 106.1 F. IV access has been obtained and normal saline has been started. What is next most effective immediate treatment for cooling?
A. Rectal Acetaminophen
B. Cooling with fans and skin wetting from a spray bottle.
C. Bladder lavage.
D. Ice packs placed on axillae and groin.
E. Cardiopulmonary bypass/ ECMO.
A 30 year old mechanic presents for a right lower leg injury. He was working on his car when it fell on his right leg. Urinanalysis reveals dark urine with a dipstick positive for large mount of blood. Serum CK is 28,000 units/L. The primary treatment modality is:
A. Sodium Bicarbonate
B. Furosemide
C. Mannitol
D. Normal Saline
E. Calcium Gluconate
Answer is D - Normal Saline
Recommend against reversal of LMWH in patients receiving prophylactic dosing of LMWH.
Low quality of evidence for the use of FFP or PCC to reverse LMWH.
Protamine:
rFVIIa: 90 ug/kg iV if Protamine is contraindicated.
A 52 year old male with history of asplenia after a car accident presents with a fever for 8 days. Tmax is 101.8. Denies any other symptoms. Denies rash. Reports he walks every morning through a path in the woods behind his house. Denies recent travel, animal exposure, sexual history. Blood pressure is 120/80, heart rate is 110, Temperature is 101.0 F, respiratory rate is 18, SpO2 is 100% on room air. Physical exam is otherwise unremarkable. Blood work is significant for evidence of hemolytic anemia and peripheral smear shows maltese cross. What is the next step in management?
Consider tick borne illness when:
Babesiosis:
Lyme's Disease:
A 2 year old boy presents with his mom for recurrent bouts of abdominal pain and vomiting. Mom denies fevers but noticed decreased appetite. Mom states there has been a "stomach bug" going around the daycare. Vitals reveal a blood pressure of 90/50, heart rate of 120, rectal temperature of 99.0, respiratory rate of 36, SpO2 of 100% on room air. Exam is unremarkable, revealing a playful child with a normal abdominal and GU exam. The nurse asks you to reassess the patient and you see a very uncomfortable child, crying and holding his abdomen, his legs drawn toward his abdomen.
Pearls from CUH Emergency Department's Conference.
