EMRAP: Global Worming

(Photo courtesy WikiCommons)

Fertilized egg of Ascaris lumbricoides. (Photo courtesy of WikiCommons)

Ascariasis is a common helminthic infection, with an estimated worldwide prevalence of 0.8-1.22 billion people. But it’s rare in the USA because it’s not endemic. Most often seen in travelers I’m inclined to think I missed cases during my years of practice.

Update your knowledge and listen to the EMRAP November podcast or hit the high points in the PDF file. Annals of Emergency Medicine: Ascariasis by Jessica Mason MD, Andy Grock MD and Andrea Tenner MD 

I’d like to hear from our Nepal colleagues’ pearls on recognition and the complications. Leave a comment. How often have you seen asymptomatic versus symptomatic cases? What’s the worst complication you’ve managed?

Who knew? “During our relatively short history on Earth, humans have acquired an amazing number of parasites, about 300 species of helminth worms and over 70 species of protozoa. Many of these are rare and accidental parasites, but we still harbor about 90 relatively common species.” Clin Microbiol Rev. 2002 Oct; 15(4): 595–612.

More on Migraine Headaches

What does a cotton swab and nose have in common? (photos from WikiCommons)

In August I posted on the common presenting complaint: migraine headaches…but there’s more.

Dr. Michelle Lin talks about anti-dopaminergic agents, triptans, IV fluids, routes of administration and steroid use. And who thought a cotton swab was your instrument of choice when treating a migraine headache? I didn’t. Check out the Lin Session: Migraine podcast from the EM:RAP November edition to add more skills to your headache arsenal.

Then add a chaser with Paper Chase #4 from the same edition which talks about parenteral acetaminophen (paracetamol). You’ll be surprised by the mechanism of action.

Who knew? The cotton swab is a tool invented in the 1920s by Leo Gerstenzang after he watched his wife attach wads of cotton to toothpicks. His product, which he named “Baby Gays“, went on to become the most widely sold brand name, “Q-tips”, with the Q standing for “quality”. (Wikipedia)

Time to Charge Your Battery…

With a jolt of information on button battery ingestions by pediatrician Ilene Claudius. The November 2017 EM:RAP edition has a podcast sure to shock you. From one end of the tail to the other, your patient outcomes can range from benign ingestion and passage over a few days to death.

A variety of button batteries found in toys. (Photo from Wikimedia Commons.)

The leakage of alkaline materials will cause liquefaction necrosis rapidly. (Photo from Wikimedia Commons.)

Button battery or coin? Read the EMRAP PDF or listen to the podcast to learn how to differentiate. (Photo from http://www.radiologypics.com)

 

The National Capital Poison Center posted the NBIH Button Battery Ingestion Triage and Treatment Guideline: https://www.poison.org/battery/guideline

Battery ingestions are no laughing matter but I can’t end without one bad joke: What did the depleted battery say to the judge? “Feel free to charge me.”

 

Dizziness-The Facts Will Sway You

“Doctor, I am dizzy.”

Dizziness is a common presenting patient complaint. When is it serious and when is it benign. For back pocket HINTS on how to differentiate Posterior Circulation Strokes from weak and dizzy listen to this September podcast. It’s available using your CMES thumbdrives or CMES-Pi.

Posterior Circulation Stroke vs. No Big Deal (THE HINTS EXAM) Anand Swaminathan MD and Evie Marcolini MD 

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