John Cafaro MD

Board Review: Anti-epileptics

Which anti-epileptic is most likely to cause hyponatremia? 

A. Carbamazepine

B. Dilantin

C. Valproic Acid 

D. Lacosamide

E. Levetiracetam

 

 

 

 

 

Answer is A - Carbamazepine or Tegretol

Bonus Question: What is the first line management in Trigeminal Neuralgia? 

 

 

 

 

 

Answer: Carbamazepine or Tegretol

 

Topic: 
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Board Review: Hyperthermia and Altered Mental Status

A 40 year old man presents via ambulance after he was found stumbling around a park on a hot summer day. He is mumbling, not responding to questions appropriately, and very disoriented. His skin is dry and hot to touch. Rectal temperature is 106.1 F. IV access has been obtained and normal saline has been started. What is next most effective immediate treatment for cooling?

A. Rectal Acetaminophen

B. Cooling with fans and skin wetting from a spray bottle.  

C. Bladder lavage. 

D. Ice packs placed on axillae and groin. 

E. Cardiopulmonary bypass/ ECMO. 

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Board Review: Crush Injury

A 30 year old mechanic presents for a right lower leg injury. He was working on his car when it fell on his right leg. Urinanalysis reveals dark urine with a dipstick positive for large mount of blood. Serum CK is 28,000 units/L. The primary treatment modality is: 

A. Sodium Bicarbonate

B. Furosemide

C. Mannitol

D. Normal Saline

E. Calcium Gluconate

 

 

 

 

Answer is D - Normal Saline

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#EMConf: Reversal of Lovenox

Recommend against reversal of LMWH in patients receiving prophylactic dosing of LMWH. 

Low quality of evidence for the use of FFP or PCC to reverse LMWH. 

Protamine:

  • Dosed within 8 hours - 1 mg IV per 1 mg Lovenox (up to 50 mg in a single dose).
  • Dosed within 8-12 hours - 0.5 mg IV per 1 mg Lovenox (up to 50 mg in a single dose). 
  • Minimal utility in reversal of >12h from dosing. 

rFVIIa: 90 ug/kg iV if Protamine is contraindicated. 

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Board Review: Infectious Disease

A 52 year old male with history of asplenia after a car accident presents with a fever for 8 days. Tmax is 101.8. Denies any other symptoms. Denies rash. Reports he walks every morning through a path in the woods behind his house. Denies recent travel, animal exposure, sexual history. Blood pressure is 120/80, heart rate is 110, Temperature is 101.0 F, respiratory rate is 18, SpO2 is 100% on room air. Physical exam is otherwise unremarkable. Blood work is significant for evidence of hemolytic anemia and peripheral smear shows maltese cross. What is the next step in management? 

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