altAt the Los Angeles County-University of Southern California Medical Center, we operate a hyperbaric chamber for the treatment of diving injuries. Our chamber is located on beautiful Santa Catalina Island off the coast of Los Angeles. When patients are triaged to the chamber via Baywatch (that’s right, our EMS providers out on the coast are actually referred to as Baywatch!), our faculty and residents fly out by helicopter from the Medical Center to meet them at the chamber.

altDr. LoPresti has a knack for making sense of thyroid emergencies.  You’ll remember from last month that he used the term “decompensated hypothyroidism” instead of myxedema coma.  He explained that patients who are hypothyroid, and thus have a decreased metabolic rate, conserve heat by being in a constant state of vasoconstriction.  That is why they feel cool to the touch....

altOn the EM:RAP program, Mel Herbert and I recently did a two-part series on two rare and exotic emergencies – myxedema coma and thyroid storm. Our expert for this segment was Dr. Jonathan LoPresti, a senior endocrinologist and thyroid researcher at LA County/USC Medical Center.

altThis is the second of a two part series on stroke syndromes. In last month’s EM:RAP column, we highlighted important differences among the various types of hemorrhagic strokes. This month, we turn our focus to ischemic stroke, which is more common, and by far the leading cause of severe disability in the developed world.

altIn this month’s EM:RAP, we discussed several aspects of stroke in the emergency department. Stroke is now the second leading cause of death in the developed world and the leading cause of severe disability. With all of the controversy surrounding tPA in stroke, we often lose sight of all of the other things that are equally, if not more important, in stroke management.

Ahbinav Chandra and colleagues looked at 10,145 patients over two years who had presented to multiple EDs with the complaint of chest pain. After a negative work-up (non-diagnostic ECG changes, normal initial biomarkers, and a non-MI impression) the EP had stratified each patient as non-cardiac, low risk, high risk, or unstable angina, based solely on their gut instinct.  How right were they? 

In general, toxic alcohols can be divided into two groups based on similarity in symptoms, pathophysiology, and treatment: isopropyl alcohol and ethanol in one group, methanol and ethylene glycol in the other. Isopropyl alcohol can be considered a “super alcohol” with more profound intoxication effects than ethanol and greater propensity for gastrointestinal bleeding from hemorrhagic gastritis.
At a recent All L.A. Conference, a panel of guest speakers from several emergency departments throughout Southern California discussed a few current updates and controversies in the management of trauma patients
There are a multitude of definitions and cut-off values for the varying degrees of  hypothermia. Mild hypothermia (34 - 35C or 93.2 -95F) is considered the excitation phase wherein shivering occurs and cardiac output increases. In moderate hypothermia (30 - 34C or 86 – 93.2F) the adynamic phase, cardiac output begins to drop.
D-dimer assays have been previously hypothesized to be useful for many disease entities including pulmonary embolism, disseminated intravascular coagulation (DIC) and subarachnoid hemorrhage (sampled from the CSF). Now, D-dimer is being considered for the evaluation of possible aortic dissection. 10 in 100,000 Americans will experience an aortic dissection annually with 38% being misdiagnosed initially. Clearly, we need help making this diagnosis. However, is D-dimer the right tool?

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