ED syndromic surveillance for novel H1N1 spring 2009.

PURPOSE: The aim of this study is to demonstrate the use of emergency department (ED) syndromic surveillance in the setting of a novel and unexpected H1N1 influenza outbreak. BASIC PROCEDURES: Data collection from ED electronic medical records was used to track initial chief complaint and discharge International Classification of Diseases, Ninth Revision, codes related to influenza-like illness (ILI). An alert threshold was generated using cumulative sum sequential analysis technique. The data were retrospectively analyzed to identify alerts that correlated with novel influenza H1N1 illness. MAIN FINDINGS: Our system alerted for ILI earlier than both the official national Centers for Disease Control and Prevention (CDC) press release for novel H1N1 and the first laboratory confirmed case in our county. PRINCIPAL CONCLUSIONS: Emergency department syndromic surveillance can be used to detect unexpected ILI before laboratory confirmation and serve as an adjunct to traditional laboratory-guided public health alerts. Early identification may allow for more efficient laboratory testing and early implementation of respiratory isolation precautions.

Pseudo-myocardial infarction in diabetic ketoacidosis with hyperkalemia.

Hyperkalemia-induced electrocardiogram changes such as dysrhythmias and altered T wave morphology are well described in the medical literature. Pseudo-infarction hyperkalemia-induced changes are less well known, but present a unique danger for the clinician treating these critically ill patients. This article describes a case of pseudo anteroseptal myocardial infarction in a type 1 diabetic with hyperkalemia. The most common patterns of pseudo-infarct and their associated potassium concentrations are then summarized from a literature review of 24 cases.

Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease compressibility.

OBJECTIVES: The aim of this study is to determine which maneuvers result in greatest cross-sectional area (CSA) of the internal jugular vein (IJV) and reduce collapsibility as measured by ultrasound during simulated venipuncture. METHODS: A total of 52 healthy adult volunteers were prospectively studied in an academic emergency department. Cross-sectional area of the IJV was recorded at baseline, with Valsalva, hepatic pressure, and a combination of hepatic pressure plus Valsalva. Subjects were studied in supine and Trendelenburg. Measurements were repeated using pressure applied to the ultrasound transducer to simulate venipuncture and evaluate degree of IJV collapse. Repeated measures analysis of variance models were used to assess the effects of the maneuvers on the diameter equivalent of the cross-sectional area (CRADE). RESULTS: With simulated venipuncture, both Valsalva and Trendelenburg position were significantly (P < .0001) associated with increased CSA of the IJV. Valsalva in either Trendelenburg or supine position was associated with the largest CRADE (1.20 and 1.13 cm, respectively). Without simulated venipuncture, CSA of the IJV were increased in all settings (P < .0001), but the relative impacts of Valsalva and Trendelenburg position were similar. Hepatic pressure had no impact on CSA of the IJV (P = .94). CONCLUSIONS: All maneuvers with the exception of hepatic pressure led to a statistically significant increase in IJV CSA as compared with baseline with and without simulated venipuncture. Valsalva was the only maneuver, when used alone or in combination, to increase the CSA by greater than 50% and prevent collapse by 50% or more under simulated venipuncture.

Formal testing and utilization of streaming media to improve flight crew safety knowledge.

Increased concerns over the safety of air medical transport have prompted development of novel ways to increase safety. The objective of our study was to determine if an Internet streaming media safety video increased crew safety knowledge. 23 out of 40 crew members took an online safety pre-test, watched a safety video specific to our program and completed immediate and long-term post-testing 6 months later. Mean pre-test, post-test and 6 month follow up test scores were 84.9%, 92.3% and 88.4% respectively. There was a statistically significant difference in all scores (p

Pediatric hypocalcemic seizures: a case of rickets.

Although cases of Vitamin D-deficient Rickets have declined since the Industrial Revolution, certain populations remain at risk. Risk factors for developing vitamin D-deficient Rickets include breast-feeding without formula or vitamin supplementation, very dark skin and inadequate exposure to sunlight. We describe a case of Rickets in a breastfed infant with dark skin who presented with hypocalcemic seizures. The pathophysiology of Rickets is briefly described along with the emergency management of infants presenting with hypocalcemic seizure.

Acquired factor VIII inhibitor presenting as a tongue hematoma.

Acquired hemophilia is a rare disorder that has potentially disastrous consequences if not recognized and treated in the setting of acute hemorrhage. We report a case of undiagnosed acquired hemophilia due to factor VIII inhibitor in which a tongue hematoma was the chief manifestation. Diagnosis, acute management, and long-term therapeutic options are reviewed.