{"id":1496,"date":"2017-05-17T19:36:02","date_gmt":"2017-05-17T23:36:02","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1496"},"modified":"2017-05-17T19:36:02","modified_gmt":"2017-05-17T23:36:02","slug":"ep-24-preeclampsia-scombroid-influenza-arterial-aneurysms-globe-rupture-hace-and-more","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-24-preeclampsia-scombroid-influenza-arterial-aneurysms-globe-rupture-hace-and-more\/","title":{"rendered":"Podcast Ep 24: Preeclampsia, Scombroid, Influenza, HACE, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_24_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Shoot for the moon and if you miss you will be among the stars.<\/p><cite>-Les Brown<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 24! We are coming to you live from Orlando at <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"http:\/\/www.saem.org\" target=\"_blank\">SAEM<\/a> this week. Ok, it is not exactly live, but we are launching this episode from Orlando. Although the venue has changed, we have the same high-quality review for you this week. This week we begin with a renal rapid review and then get into the new material, starting with some OB and virology, and ending with the more obscure, but still important, altitude-related emergencies. Hope you enjoy!<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>When considering <strong>children<\/strong> with <strong>glomerulonephritis<\/strong>, in a child with <strong>mild to moderate edema<\/strong>, a <strong>normal blood pressure<\/strong>, and <strong>no respiratory<\/strong> <strong>symptoms<\/strong>, <strong>discharge home<\/strong> with <strong>corticosteroids<\/strong> may be appropriate.<\/li><li><strong>Winter\u2019s formula<\/strong>, <strong>pCO2 = 1.5HCO<sub>3<\/sub><sup>&#8211;<\/sup> + 8 \u00b1 2,<\/strong> is used to determine if there is <strong>appropriate respiratory compensation in a metabolic acidosis<\/strong>. &nbsp;<\/li><li>The causes of a <strong>non-anion gap metabolic acidosis<\/strong> can be remembered with the mnemonic <strong>HARDASS: Hyperalimentation, Addison\u2019s disease, RTA, Diarrhea, Acetazolamide, Spironolactone, and Saline infusion.<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Now onto this week&#8217;s podcast<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 1<\/strong><\/p>\n\n\n\n<p>A 17-year-old G1P0 woman at 25 weeks gestation presents with intermittent blurred vision. On presentation, she is asymptomatic. Vital signs are HR 84, BP 175\/113, and oxygen saturation 97%. Physical examination reveals 2+ pitting edema on both lower extremities and urinalysis has 3+ protein on dip. Which of the following is most likely indicated?<\/p>\n\n\n\n<p><span>A. Admit for further obstetrics evaluation<\/span><\/p>\n\n\n\n<p><span>B. Antiepileptic medications<\/span><\/p>\n\n\n\n<p><span>C. Arrange follow-up with the patient\u2019s obstetrician<\/span><\/p>\n\n\n\n<p><span>D. Emergency cesarean section<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-Preeclampsia-and-Severe-Preeclampsia.jpeg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 2<\/strong><\/p>\n\n\n\n<p>Which of the following fish poisonings is associated with a peppery taste?<\/p>\n\n\n\n<p><span>A.<em> Aeromonas<\/em><\/span><\/p>\n\n\n\n<p><span>B. Ciguatera<\/span><\/p>\n\n\n\n<p><span>C. Scombroid<\/span><\/p>\n\n\n\n<p><span>D.<em> Vibrio<\/em><\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-Scombroid.jpeg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 3<\/strong><\/p>\n\n\n\n<p>What is the most common cause of viral pneumonia in adults?<\/p>\n\n\n\n<p><span>A. Influenza virus<\/span><\/p>\n\n\n\n<p><span>B. Metapneumovirus <\/span><\/p>\n\n\n\n<p><span>C. Parainfluenza virus<\/span><\/p>\n\n\n\n<p><span>D. Respiratory syncytial virus<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-Influenza.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 4<\/strong><\/p>\n\n\n\n<p>Which of the following is the most common visceral artery aneurysm?<\/p>\n\n\n\n<p><span>A. Hepatic artery aneurysm<\/span><\/p>\n\n\n\n<p><span>B. Inferior mesenteric artery aneurysm<\/span><\/p>\n\n\n\n<p><span>C. Splenic artery aneurysm<\/span><\/p>\n\n\n\n<p><span>D. Superior mesenteric artery aneurysm<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-Risk-Factors-Visceral-Artery-Aneurysms.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 5<\/strong><\/p>\n\n\n\n<p>A 14-year-old girl is brought to your mountaineering base camp at 11,000 feet for evaluation of strange behavior while attempting to summit a nearby peak with her school group. What is the most sensitive clinical sign in diagnosing high-altitude cerebral edema?<\/p>\n\n\n\n<p><span>A. Cerebellar ataxia <\/span><\/p>\n\n\n\n<p><span>B. Cranial nerve VI palsy<\/span><\/p>\n\n\n\n<p><span>C. Ptosis<\/span><\/p>\n\n\n\n<p><span>D. Seizure<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-HACE.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 6<\/strong><\/p>\n\n\n\n<p>A 33-year-old man presents to the ED with right eye pain, tearing, and \u201cdifficulty seeing\u201d out of the right eye. His visual acuity is 20\/30 on the left and 20\/200 on the right. On physical exam, you notice a subconjunctival hemorrhage and teardrop-shaped pupil. Which of the following physical exam findings is consistent with the suspected diagnosis?<\/p>\n\n\n\n<p><span>A. Cells and flare in the anterior chamber on slit lamp exam<\/span><\/p>\n\n\n\n<p><span>B. Gross retinal hemorrhage on dilated funduscopic exam<\/span><\/p>\n\n\n\n<p><span>C. Intraocular pressure measurement of 52 mm Hg<\/span><\/p>\n\n\n\n<p><span>D. Positive Seidel test on fluorescein stain exam<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-Globe-Rupture.jpeg\">Teaching Image<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep24-Positive-Seidel.mp4\">Teaching Video<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Preeclampsia<\/strong> is defined as gestational hypertension <strong>after 20 weeks<\/strong>, with a <strong>blood pressure of 140\/90 or higher<\/strong> and either <strong>proteinuria or signs of end-organ damage<\/strong>.<\/li><li>The <strong>definitive<\/strong> and curative <strong>therapy<\/strong> for <strong>preeclampsia<\/strong> is <strong>delivery<\/strong> of the baby.&nbsp;<strong>Magnesium<\/strong> may be given for <strong>seizure prophylaxis<\/strong>.<\/li><li>Both <strong>hydralazine<\/strong> and <strong>labetalol<\/strong> can be safely used in <strong>pregnancy<\/strong> to control <strong>blood pressure<\/strong>.<\/li><li><strong>HELLP<\/strong> syndrome is a severe <strong>variant or complication<\/strong> of <strong>preeclampsia<\/strong>. It is characterized by <strong>hemolysis, elevated liver enzymes, and low platelets<\/strong>.<\/li><li><strong>Scombroid<\/strong> <strong>poisoning<\/strong> may cause a <strong>metallic, bitter, or even peppery taste<\/strong>.<\/li><li><strong>Scombroid poisoning<\/strong> results from the <strong>breakdown of histidine into histamine<\/strong> resulting in <strong>facial flushing, diarrhea, severe throbbing headache, palpitations, and abdominal cramps<\/strong>.<\/li><li><strong>Ciguatera poisoning<\/strong> leads to <strong>nausea, vomiting, diarrhea, myalgias, tingling and numbness, abdominal pain, and vertigo<\/strong> along with the classic association of <strong>hot and cold sensation reversal<\/strong>. In <strong>severe cases, hypotension, bradycardia, and coma<\/strong> may result.<\/li><li>The <strong>most common viral<\/strong> <strong>cause<\/strong> of <strong>pneumonia<\/strong> in <strong>adults<\/strong> is <strong>influenza<\/strong>.<\/li><li><strong>Influenza<\/strong> is also the <strong>most common viral<\/strong> <strong>cause<\/strong> of <strong>rhabdomyolysis<\/strong>.<\/li><li><strong>Splenic artery aneurysms<\/strong> are the <strong>most common visceral artery aneurysm<\/strong>.<\/li><li><strong>Splenic artery aneurysms<\/strong> are managed with <strong>embolization in asymptomatic<\/strong> patients and <strong>operatively<\/strong> in those who are <strong>symptomatic<\/strong>.<\/li><li>The <strong>most sensitive clinical sign<\/strong> for diagnosis of high altitude cerebral edema (<strong>HACE<\/strong>) is <strong>cerebellar ataxia<\/strong>. Other signs include <strong>encephalopathy<\/strong>, severe <strong>lassitude<\/strong>, and a progressive <strong>decline of mental function<\/strong> and consciousness.<\/li><li><strong>HACE<\/strong> is managed definitively with <strong>descent<\/strong>. <strong>Steroids<\/strong>, <strong>supplemental oxygen<\/strong>, and <strong>hyperbarics<\/strong> may also be used.<\/li><li><strong>Globe rupture<\/strong> can be identified by a <strong>positive Seidel test<\/strong> on fluorescein stain exam. CT can also help in making the diagnosis.<\/li><li><strong>Globe rupture<\/strong> should be managed by <strong>covering the eye with a shield<\/strong>, <strong>elevating the head of the bed<\/strong>, <strong>updating the tetanus vaccine<\/strong>, and starting <strong>antibiotics<\/strong>. <strong>Operative emergent repair<\/strong> is a must.<\/li><\/ul>\n\n\n\n<p>So that wraps up Episode 24. We will be in Orlando for a few more days, so please stop us and let us know what you think. We are always looking for ways to make Roshcast even better and are open to any ideas and suggestions. As always, don\u2019t forget to follow us on Twitter @Roshcast for updates, high-yield images, and pearls in 140 characters or less.<\/p>\n\n\n\n<p>Until next time,<br>Jeff and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Shoot for the moon and if you miss you will be among the stars. -Les Brown Welcome back to Episode 24! We are coming to you live from Orlando at SAEM this week. Ok, it is not exactly live, but we are launching this episode from Orlando. Although the venue has changed, we have the <a href=\"https:\/\/www.roshreview.com\/blog\/ep-24-preeclampsia-scombroid-influenza-arterial-aneurysms-globe-rupture-hace-and-more\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":851,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2038,2039,2128,2289,2352,2387,2417,2498,2506,2575,2592,2604,2633,2710,2726,2744,2757,2763,2771,2799,2805,2806,2818,2823,2828,2848,2881,2933,2942,2994,3079,3091,3132,3150,3161,3182,3202,3276,3369,3370,3388,3469,3511,3517,3518,3562,3580,3607,3638,3659,3669,3748,3757,3758,3767],"coauthors":[],"class_list":["post-1496","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-abdominal-cramping","tag-abdominal-pain","tag-altitude","tag-bradycardia","tag-cerebellar-ataxia","tag-ciguatera","tag-coma","tag-descent","tag-diarrhea","tag-embolization","tag-encephalopathy","tag-environmental","tag-facial-flushing","tag-gestational-hypertension","tag-globe-rupture","tag-hace","tag-headaches","tag-hellp","tag-hemolysis","tag-high-altitude-cerebral-edema","tag-histamine","tag-histidine","tag-hot-and-cold-sensation-reversal","tag-hydralazine","tag-hyperbaric","tag-hypotension","tag-influenza","tag-labetalol","tag-lassitude","tag-magnesium","tag-myalgias","tag-nausea","tag-numbness","tag-obstetrics","tag-ophthalmology","tag-oxygen","tag-palpitations","tag-peppery-taste","tag-preeclampsia","tag-pregnancy","tag-proteinuria","tag-rhabdomyolysis","tag-scombroid","tag-seidel-test","tag-seizure","tag-splenic-artery-aneurysm","tag-steroids","tag-surgery","tag-tetanus","tag-tingling","tag-toxicology","tag-vertigo","tag-viral-pneumonia","tag-visceral-artery-aneurysm","tag-vomiting"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.7 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Podcast Ep 24: Preeclampsia, Scombroid, Influenza, HACE, &amp; More - RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 24), the first question and answer style emergency medicine podcast. 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