Tintinalli Emergency Medicine' title='Tintinalli Emergency Medicine' />The wrist is the most commonly injured region of the upper extremity. Fractures of the distal radius and ulna account for three fourths of wrist injuries. Advanced search allows to you precisely focus your query. Search within a content type, and even narrow to one or more resources. You can also find results for a. The Harbor DEM faculty consists of 25 members who hold academic appointments at the David Geffen School of Medicine at UCLA and are members of the Professional Staff. Anaphylaxis Symptoms, Treatment Causes. What are common causes of anaphylaxis The major causes of anaphylaxis include medications, foods, drugs, latex, and insect bites or stings wasps, yellow jackets, hornets, honeybees, and fire ants, and latex. The causes of anaphylaxis are divided into two major groups Ig. The OHSU Department of Emergency Medicine Faculty Directory. Emergency medicine, also known as accident and emergency medicine, is the medical specialty involving care for undifferentiated and unscheduled patients with. Increasing political tensions, terrorist groups, and general turmoil faced around the world makes the possibility of a biological, chemical, or other attack on. Read about anaphylaxis and how it differs from an allergic reaction. Learn about shock, symptoms, treatment, diagnosis, causes insect stings, latex allergy, food. Central European Emergency Medicine 2017 October 18 th 21 st, 2017, Lublin, Poland 6. Midzynarodowy Kongres Polskiego Towarzystwa Medycyny Ratunkowej. E mediated This form requires an initial sensitizing exposure an exposure to the substance that will later trigger the anaphylaxis and then occurs on a subsequent exposure. It involves the coating of mast cells and basophils cells in the blood and tissue that secrete mediators, the substances that cause allergic reactions by an antibody called Ig. E, and the subsequent release of chemical mediators upon re exposure. BONUS William Joseph Howes Emergencies and How to Treat Them, was published in New York City in 1871. Download a PDF copy of this first Emergency Medicine textbook. Kidney Stones The kidney filters waste products and excess water from the body. Sometimes, because of factors that include heredity, learn more. Ig. E mediated anaphylaxis can occur with foods, drugs, latex, and insect stings. Although it may appear that Ig. E mediated anaphylaxis occurs upon a first exposure to a food, drug, or insect sting, there must have been a prior sensitization from a previous exposure, which is often unknown. One may not remember an uneventful sting. The previous exposure to a food may not be recalled it may occur in utero, through breast milk, or through the skin, particularly in individuals with eczema atopic dermatitis. Non Ig. E mediated These reactions have the same symptoms as true anaphylaxis but do not require an Ig. E immune reaction. They are usually caused by the direct stimulation of the mast cells and basophils. In the past, they have been termed anaphylactoid reactions. The same mediators are released as with Ig. E mediated anaphylaxis, and the same effects are produced. This reaction can happen on initial, as well as subsequent, exposures, since no sensitization is required. This type of reaction usually occurs with medications. A common cause of a non Ig. E mediated reaction is IV contrast used in imaging studies. Prehospital Care, Emergency Department Care, Therapeutic Dilemmas. Cocaine associated cardiac arrest. Current American Heart Association AHA guidelines note that no data exist to support the use of cocaine specific interventions in cardiac arrest due to cocaine overdose. Instead, resuscitation should follow standard Basic Life Support and Advanced Cardiac Life Support algorithmsACLS. Cocaine associated acute coronary syndrome. The AHA guidelines note that clear evidence exists that cocaine can precipitate acute coronary syndrome ACS, and it may be reasonable to try agents that have shown efficacy in the management of ACS in patients with severe cardiovascular toxicity. Agents that may be used as needed to control hypertension, tachycardia, and agitation include the following 4. Alpha blockers phentolamine. Canon Lbp 2900B Printer Software. Benzodiazepines lorazepam, diazepam. Calcium channel blockers verapamil. Morphine. Sublingual nitroglycerin NTG. The AHA does not recommend any one of those agents over another in the treatment of cardiovascular toxicity due to cocaine. Cocaine associated cardiac dysrhythmias. Ventricular ectopy is usually transient and is managed with careful observation and escalating doses of benzodiazepine to blunt the hypersympathetic state by modulating cocaine induced CNS stimulation. Treat malignant ventricular ectopy and perfusing ventricular tachycardia VT by ensuring good oxygenation, by treating the hyperadrenergic state with escalating doses of benzodiazepine, and by administering appropriate antidysrhythmic medications if ventricular arrhythmias persist. Ensure that a defibrillator is readily available. Consider sodium bicarbonate for treating dysrhythmias resulting from the direct toxic effects of cocaine, 4. QRS 1. 00 milliseconds. Dual mechanisms of action have been proposed for its therapeutic effects 1 Alterations in p. H may change the conformation of the sodium channel, and 2 increased extracellular sodium concentrations may override sodium channel blockade. Hourly measurements of blood p. H are indicated, with appropriate adjustments until the blood p. H is properly controlled. End points of bicarbonate therapy are a serum p. H of 7. 5. 0 7. 5. Paroxysmal supraventricular tachycardia PSVT, atrial flutter, and rapid atrial fibrillation are generally short lived and do not require immediate treatment. Use escalating doses of benzodiazepine to treat hemodynamically stable patients with persistent supraventricular arrhythmias to blunt the hypersympathetic state by modulating cocaine induced stimulation of the CNS, taking caution not to depress consciousness and create a need for respiratory assistance. In drug induced hemodynamically significant tachycardia, the pathophysiologic mechanism responsible may be increased automaticity, triggered activity, or reentry phenomenon. Tachycardia caused by increased automaticity will not be responsive to interventions such as adenosine and synchronized cardioversion. Benzodiazepines are generally safe and effective in drug induced hemodynamically significant tachycardia. Cocaine associated chest pain and MIChest pain may result from musculoskeletal, cardiovascular, pulmonary, or other causes. Risk of myocardial infarction is highest within the first hour following cocaine use. In patients with cocaine related chest pain, assume that cardiac ischemia is present until this is proven otherwise. Accordingly, the ED approach to such patients, in addition to oxygen, intravenous access, and monitoring, includes the steps outlined below. Perform 1. 2 lead ECG. Obtain chest imaging. Direct the initial pharmacologic approach to suspected cocaine related myocardial ischemia at increasing coronary blood flow and decreasing sympathetic output. The American College of Cardiology FoundationAmerican Heart Association ACCFAHA 2. ST segment elevation myocardial infarction include the following class I recommendations for treatment of patients with ischemic chest discomfort and  ST segment elevation or depression after cocaine use 3. Administer sublingual or intravenous IV NTG and IV or oral calcium channel blockers eg, diltiazem, 2. IV. In patients whose ST segments remain elevated after NTG and calcium channel blockers, perform immediate coronary angiography, if possible if occlusive thrombus is detected, percutaneous coronary intervention is recommended. Fibrinolytic therapy is useful in patients with ischemic chest discomfort after cocaine use if ST segments remain elevated despite NTG and calcium channel blockers and coronary angiography is not possible however, fibrinolysis is often contraindicated. AHA guidelines note that patients with cocaine induced hypertension or chest discomfort may also benefit from benzodiazepines andor morphine, in addition to NTG. Small, incremental doses of benzodiazepines decrease norepinephrine release by the CNS, thereby counteracting the sympathomimetic effects of cocaine on the heart. Similar doses of morphine sulfate MS also alter hemodynamics and blood flow dramatically in patients with heightened sympathetic activity. Limiting factors for morphine and benzodiazepines include hypotension, somnolence, and respiratory depression. Kercher cautions that short acting benzodiazepines eg, lorazepam should be prescribed at low doses for patients with hepatic disease, organic brain syndrome, and those taking medications inhibiting the metabolism and clearance of benzodiazepines eg, those using nicotine or cimetidine. In patients with prolonged unexplained chest pain, perform serial ECGs and cardiac marker measurements to rule out MI. However, in one study, Hollander reports that patients with MI were as likely to present with normal or nonspecific ECG findings as with ischemic ECG findings. The sensitivity of the ECG in predicting MI was only 3. ECG appears to be less sensitive in patients with cocaine induced myocardial ischemia than in other patients presenting with ischemic chest pain. Interpretation of cardiac markers in patients with cocaine induced symptoms may be difficult since levels of creatine kinase CK and CK MB isoform CK MB may be elevated in cocaine users who do not have an MI. However, the specificity of troponin assays is not affected by cocaine use. Be mindful that as many as 4. ECG criteria for fibrinolysis despite being cardiac marker negative for infarction a high percentage of such patients have early repolarization. Of additional importance, an increased incidence of mycotic aneurysms and CNS mass lesions may lead to an increased incidence of hemorrhagic complications in these patients. When evaluating patients for fibrinolytic therapy, remember that a history of intravenous drug use poses a relatively high risk for the possibility of coexisting vascular pathology. Obtain a detailed history and perform physical and ancillary testing, as appropriate, directed at identifying endocarditis, septic pulmonary emboli, and pseudoaneurysm. AHA 2. 00. 5 Guidelines state that intracoronary administration of fibrinolytics is preferred to blind peripheral administration in patients with drug induced acute coronary syndrome. Fibrinolysis in the presence of hypertension or CNS vasculitis may be dangerous, and percutaneous transluminal coronary angioplasty PTCA may be a safer alternative when revascularization is indicated.