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In the spectrum of heat related illness, heat stroke is a can’t miss diagnosis. Aggressive management, with rapid cooling to 38-39°C within 30 minutes of presentation at a rate of 0.20-0.35°C per minute has been shown to not only be safe but improve outcomes.
Source
Treatment and Prevention of Heat-Related Illness. N Engl J Med. 2022 Oct 13;387(15):1404-1413. doi: 10.1056/NEJMcp2210623. Epub 2022 Sep 28.
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Drowning is a common cause of death worldwide. The duration of submersion is the best predictor of outcome, with immediate on-scene CPR and ventilation improving outcomes. Prevention is the best medicine, with public health intervention and policy being the most effective way to prevent drowning.
Source
Prevention of and Emergency Response to Drowning. NEJM 2022 Oct 6. Doi:10.1056/NEJMra2202392
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The incidence of frostbite is shifting from exploration to urban environments and requires prompt recognition and often presents with other disease processes. Standard treatment is supportive and conservative, but new therapies including direct and systemic thrombolysis, and anticoagulation may be the future.
Source
Diagnosis and Treatment of Frostbite. NEJM. 2022;386(26):2213-2220. Doi:10.1056/NEJMra1800868
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Decompression sickness and arterial gas embolism can present similarly and have similar treatment protocols. Decompression illness is a term that can encompass both disease processes. Recompression and hyperbaric oxygen are definitive treatments for both conditions. If you need additional help, you should contact a 24-hour expert on the topic.
Source
Decompression Sickness and Arterial Gas Embolism. NEJM. 2022;386:1254-1264. DOI: 10.1046/NEJMra2116554
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Snake envenomation has a large global health burden with a variety of clinical presentations from benign to life threatening. Early use of antivenom (if available), good supportive care, and admission for further treatment and observation is the best management regardless of the snake species involved.
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Patients treated with hyperbaric oxygen therapy within 6 hours of carbon monoxide exposure had better 6-month neurocognitive outcomes than patients who received treatment within 6-24 hours. Poor outcomes increased as time-to-treatment increased.
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This literature review of crotalid envenomation answers 8 clinical questions for ED docs.
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Cold water immersion resulted in significantly faster cooling rates for patients with exertional hyperthermia compared to passive cooling measures.
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Patients with severe renal dysfunction receiving high dose cefepime may have higher risk of cefepime-associated neurotoxicity.
The incidence of cancer was higher in children exposed to low-dose diagnostic radiation than to non-exposed children. Be circumspect in scanning kids.
