EM Quick Hits 25 Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis

Emergency Medicine Cases - En podcast af Dr. Anton Helman - Tirsdage

Kategorier:

Topics in this EM Quick Hits podcast Justin Morgenstern on when to consider cerebral venous thrombosis (00:53) Maria Ivankovic on diphenhydramine alternatives (07:38) Brit Long on abdominal compartment syndrome (13:13) Sarah Reid on neonatal constipation  (19:37) Anand Swaminathan on intubating metabolic acidosis (27:40) Podcast production, editing and sound design by Anton Helman; voice editing by Raymond Cho Podcast content by Justin Morgenstern, Maria Ivankovic, Brit Long, Sarah Reid, Anand Swaminathan & Anton Helman  Written summary & blog post by Graham Mazereeuw, edited by Anton Helman Cite this podcast as: Helman, A. Morgenstern, J. Ivankovic, M. Long, B. Reid, S. Swaminathan, A. EM Quick Hits 25 - Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis. Emergency Medicine Cases. January, 2021. https://emergencymedicinecases.com/em-quick-hits-january-2021/. Accessed [date]. When to Consider Cerebral Venous Thrombosis Presentation is nonspecific and highly variable: * Headache in nearly all patients (the only symptom in 25% of patients) * Other features: focal neurological deficit (40%), seizure (40%), encephalitis (rarely) Key demographics: * Young (39 years old on average) * Female (3x more commonly) * Usually at least one thrombotic risk factor Consider this diagnosis in 4 groups of patients: Group 1: severe or prolonged headache without a clear cause and with at least one thrombotic risk factor Group 2: thunderclap headache with a negative CT head Group 3: severe headache with stroke symptoms or neurological findings not clearly mapping to a vascular territory Group 4: intracranial hemorrhage without a classic bleeding pattern, particularly younger patients or those with thrombotic risk factors -MR venogram is gold standard; contrast CT venogram has good sensitivity (95%) -Treat the sequelae (ABCs, treat seizure, treat raised ICP) -Specific treatment is anticoagulation (even if intracranial hemorrhage!) in consultation with neurology/hematology -Full recovery = 80%; 30-day mortality = 5% Bottom line: CVT is the DVT of the brain; be on high alert for CVT in patients with thrombotic risk factors and atypical headache or stroke symptoms. Expand to view reference list * Tadi P, Behgam B, Baruffi S. Cerebral Venous Thrombosis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459315/ Diphenhydramine Alternatives * First-generation antihistamines are “dirty drugs”: diphenhydramine and hydroxyzine have poor receptor selectivity, binding muscarinic, serotonergic, and alpha-adrenergic receptors, as well as cardiac potassium channels in addition to the H1 histamine receptor * First-generation antihistamines side effects: * CNS suppression, psychomotor impairment, delirium, coma, and death * QT prolongation and torsades de pointes * Recreational misuse ("Benadryl challenge" parties) * A therapeutic dose of diphenhydramine (50mg) can impair driving similarly to a 0.