EM Quick Hits 2 Organophosphate Poisoning, TXA for Hemoptysis, Metacarpal Fracture Rotation, Abdominal Stab Wounds, Pediatric IV Cannulation

Topics in this EM Quick Hits podcast Emily Austin on organophosphate poisoning (0:30) Arun Sayal on malrotation of metacarpal fractures (7:20) Andrew Petrosoniak on pitfalls in abdominal stab wound management (13:30) Anand Swaminathan on tranexamic acid for non-massive hemoptysis (20:15) Natalie May on pediatric IV cannulation tips and tricks (26:07) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Emily Austin, Anand Swaminathan, Arun Sayal, Andrew Petrosoniak & Natalie May, edited by Anton Helman Cite this podcast as: Helman, A. Austin, E. Sayal, A. Petrosoniak, Swaminathan, A. May, N. EM Quick Hits 2 - Organophosphate Poisoning, TXA for Hemoptysis, Metacarpal Fracture Rotation, Abdominal Stab Wounds and Pediatric IV Cannulation. Emergency Medicine Cases. February, 2019. https://emergencymedicinecases.com/em-quick-hits-february-2019/. Accessed [date]. Organophosphate Poisoning * Poisoning with an organophosphorus compounds can presents with signs and symptoms of excess acetylcholine in the parasympathetic nervous system, the CNS, at the neuromuscular junction, and at nicotinic receptors in the sympathetic nervous system. * Cholinergic symptoms tend to dominate: think DUMBELS (diaphoresis and diarrhea; urination; miosis; bradycardia, bronchospasm, bronchorrhea; emesis; excess lacrimation; and salivation) or SLUDGE (salivation, lacrimation, urination, diarrhea, GI upset, emesis), but more importantly the “Killer Bs” of bradycardia, bronchoconstriction and bronchorrhea. * Treating these patients involves aggressive supportive care, and antidote therapy with atropine as well as pralidoxime. * Atropine is the most important antidote to give. It should be dosed at 1-2 mg IV to start, and then given at double the dose every 5 minutes until your patient has a clear chest and is hemodynamically stable. Then start an infusion at 10-20% of the total dose of atropine given per hour. Expand to view reference list * Abedin MJ, Sayeed AA, Basher A, Maude RJ, Hoque G, Faiz MA. Open-label randomized clinical trial of atropine bolus injection versus incremental boluses plus infusion for organophosphate poisoning in Bangladesh. J Med Toxicol. 2012;8(2):108-17. * Eddleston M, Dawson A, Karalliedde L, et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors. Crit Care. 2004;8(6):R391-7. * Eddleston, M et al. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371(9631):2170.. * UN General Assembly. Report of the Special Rapporteur on the right to food. (https://documents-dds-ny.un.org/doc/UNDOC/GEN/G17/017/85/PDF/G1701785.pdf?OpenElement) Malrotation in Metacarpal Fractures * Malrotation of metacarpal fractures is diagnosed clinically, not radiographically. * Malrotation is easily missed and may lead to functional impairment if not formally addressed. * Normal alignment is confirmed with all the fingers pointing to the scaphoid while all the PIPs and DIPs are flexed (see images) * 10-15% of people have some degree of scissoring at baseline or a previous injury, so it's important to compare to the contralateral hand and ask about previous hand injuries