EM Quick Hits 5 Ludwig’s Angina, Transient Monocular Vision Loss, D-dimer for PE Workup in Pregnancy, Pediatric Nasal Foreign Bodies, Trimethoprim Drug Interactions, Airway Management in Cardiac Arres

Topics in this EM Quick Hits podcast Anand Swaminathan on approach to emergency management of Ludwig's angina (00:39) Anna MacDonald on transient monocular visual loss (09:20) Mike Misch on workup of suspected PE in pregnancy (16:15) Natalie May on pediatric nasal foreign bodies tips and tricks (23:20) David Juurlink on sulfamethoxazole/trimethoprim drug interactions (29:00) Justin Morgenstern on airway management options in cardiac arrest (35:50) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Anand Swaminathan, Natalie May, Anton Helman, Justin Morgenstern, Michael Misch, Anna MacDonald and David Juurlink , edited by Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Morgenstern, J. Juurlink, D. May, N. MacDonald, A. Misch, M. EM Quick Hits 5 -Ludwig's Angina, Transient Monocular Vision Loss, PE Workup in Pregnancy, Pediatric Nasal Foreign Bodies, Sulfamethoxazole/Trimethoprim Interactions, Airway Management in Cardiac Arrest. Emergency Medicine Cases. June, 2019. https://emergencymedicinecases.com/em-quick-hits-june-2019/. Accessed [date]. Ludwig's Angina Emergency Management - Approach, Airway, Imaging * Allow the Ludwig's patient to be in their position of comfort to help maintain a patent airway * These patients will have anatomically challenging airways. If you can, get the patient to the OR for definitive management and let the airway be controlled there with someone present who can do a tracheostomy if necessary. Call your surgeon early. * If immediate control of the airway in necessary, consider awake fiberoptic nasotracheal intubation after thorough topicalization +/- low dose ketamine. A blind nasotracheal approach is a reasonable alernative if you don’t have fiberoptics. Avoid paralytics if the patient is breathing spontaneously and prepare for a cricothyrotomy. * Initiate IV broad spectrum antibiotics including coverage for anaerobes and consider IV dexamethasone as well as nebulized epinephrine * Ludwig's angina is a clinical diagnosis and does not require advanced imaging. Do not delay the patient going to the OR or getting transferred to a hospital with a surgeon for a CT. Remember that the patient has to be comfortable lying flat to get a CT. Expand to view reference list * EM: RAP HD video: Ludwig’s Angina * LITFL: Ludwig’s Angina * emDocs: EM@3AM: Ludwig’s Angina Transient Monocular Vision Loss (TMVL) Causes of TMVL * Non-inflammatory vascular causes * Emboli (TIA of the eye) * Ocular ischaemia * Impending Central Retinal Vein Occlusion (CRVO) * Giant cell arteritis (temporal arteritis) * Retinal migraine (VL should be followed by headache within 60 mins) * Optic neuritis – Uhthoff’s phenomenon * Local globe/orbit/lid problems (e.g. glaucoma, orbitopathies, hyphema, dry eyes)