Exercise Induced Anaphylaxis?! You Betcha.

Facial angioedema from allergen exposure. Photo from Wikipedia.

Think you know everything about anaphylaxis? Every see a case of Exercise Induced Anaphylaxis (EIA)? The EM:RAP October podcast called; Exercise Induced Anaphylaxis by Jess Mason MD and Gita Pensa MD will give you hives…or at least goosebumps.

Points to ponder: Is there a relationship to food? Can EIA be fatal? What are the clues to diagnosis? All these answers and more await you in this October EM:RAP podcast.

Who Knew? Professor Charles Richet was a French physiologist who coined the term aphylaxis in 1902. This was later changed to anaphylaxis and his pioneering work in Immunology earned him a Nobel Prize in Physiology or Medicine in 1913.

 

Crash Rapid Sequence Intubation (RSI): Clear the Runway for the Crashing Airway Patient

Twenty years ago I was a volunteer at a small rural hospital. A trauma patient was on the way in and I asked the nurse to prime two IV bags, open the BVM and ETT. She declined and said their policy was not to open supplies until at bedside. I get it…supplies are a resource not to be wasted…but having a dedicated airway kit prepped and ready at the bedside is crucial to RSI success.

The crash airway mnemonic SOAP ME runs down the list of everything you need for a successful Rapid Sequence Intubation (RSI) in the crashing airway patient. EM:RAP’s September podcast of Critical Care Mailbag: The Crash Checklist by Anand Swaminathan MD and Scott Weingart MD should be on everyone listening list.

Review what the mnemonic SOAP ME checklist stands for; how to temporize the crashing airway; how to treat the obstructed airway; and most importantly…tips on how to be ready for any airway headed for a crash and burn.

Heres a quick reference for SOAP ME. What’s in your kit? Leave a comment and start the dialogue.

Photo courtesy of Wikimedia Commons.

Who Knew? William Macewan (1848-1924), a Glasgow surgeon, invented a type of endotracheal tube pictured. He was the first person to use an endotracheal tube to give a patient anaesthetic, in 1878. A tube was placed in the larynx to give the patient a dose of chloroform. These examples are made from steel and brass. They range in length from 210 mm to 80 mm for patients of all sizes.

 

Bone Up on Your Rongeur Skills

EMRAP‘s YouTube channel has a plethora of tutorial videos and today’s recommendation will take less than 3 minutes to view. Take a quick review of how to rongeur a fingertip bone to facilitate skin closure. Added bonus…how to make a finger tourniquet from a glove. View here.

Who Knew? Think of a rongeur as a heavy duty forceps used to remove bone. The word is derived from the French noun meaning “rodent” or the adjective meaning “gnawing”.

To Give Steroids or Not: That is the Question

Steroid molecule. (Wikimedia Commons)

In Hamlet Act 3, scene 1, Shakespeare wrote; “To be, or not to be: that is the question”. Hamlets most famous soliloquy is both memorable and intriguing because he was contemplating profound ideas. Something you do every day, every shift and every hour while working…you contemplate decisions based on best practice, cutting-edge articles, and new research. One such question has haunted us for decades…to give or not to give steroids to septic patients.

Take a listen or read the August EMRAP article titled: Critical Care Mailbag: Steroids for Septic Patients by Anand Swaminathan MD and Scott Weingart MD for a fresh perspective.

On Jan 19th, 2018 the ADRENAL Trial results were published trying once and for all to answer the question of adjunctive steroids in septic shock. Take a look at this condensed version.

Rheumatoid arthritis (Wikimedia)

Who Knew? In 1948 the first patient with rheumatoid arthritis was treated with cortisone.  Between 1954 and 1958 six synthetic steroids were introduced for systemic anti-inflammatory therapy. By 1960 all of the toxic effects of chronic corticosteroid administration had been appreciated. In the 1970s the introduction of methotrexate helped restrict the dosages and indications for corticosteroids in the rheumatic diseases.

 

 

Testicular Torsion – A Convoluted Case

What do Chubby Checker and testicular torsion have in common? (Wikimedia photo)

The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and mild tenderness to palpation in the right lower quadrant without rebound. His abdominal ultrasound was inconclusive; the white blood cell count mildly elevated, and the urine microscopy normal. He was admitted for observation. Twelve hours later the patient developed a fever and severe groin pain. A genital exam revealed classic findings for testicular torsion. The testicle was not salvageable. Unfortunately, the patient was born monorchism and rendered sterile by the orchidectomy. The lesson from this case: always include a genital exam in patients with lower abdominal pain.

Can you rely on the history and physical exam to rule out testicular torsion? Is the testicle salvageable after 6 hours? Wrench yourself away from your music downloads and listen to the EM:RAP August podcast called Testicular Torsion by Rob Orman MD and Larry Mellick MD. Get an update and review on this twisted entity and you won’t spiral out of control when faced with the possibility.

Who Knew? “The Twist” is an American pop song written and originally released in 1959 by Hank Ballard and the Midnighters. It was made popular by Chubby Checker, an American rock n’ roll icon, who put his stamp on the song with the twist dance style.

So what do Chubby Checker and testicular torsion have in common? As Mr. Checker said, “Come on let’s twist again…”. Testicular torsion pain can come and go.