SimWars
This post is part of a series developed in preparation for participation in ACEP SimWars. It contains a review of several prominent emergency medicine topics which may be relevant for board preparation. Unless otherwise cited, content is based on HippoEM videos.
- Pediatric Emergencies
- Altitude and Dysbarism
- Bites
- Electrical Injuries
- Heat Emergencies
- Hypothermia
- Radiation Exposure
- Submersion Injury
- Hematologic Emergencies
- Bleeding Disorders
- Oncologic Emergencies
- Adrenal/Pituitary Emergencies
- Thyroid Emergencies
- Acid-Base Disturbances
- Dermatologic Emergencies
- Toxicology
Adrenal Emergencies
- Hormones: aldosterone, cortisol, androgens, catecholamines
- Adrenal insufficiency
- Primary
- Causes
- Autoimmune (associated with other endocrinopathies, PTH, DM)
- Infection (TB, viral, meningococcemia)
- Infiltration (sarcoidosis, amyloidosis)
- Hemorrhage (trauma, anti-coagulation)
- Malignancy (primary, metastatic)
- Signs/Symptoms
- AMS
- Hypotension (refractory)
- GI: anorexia, nausea/vomiting, diarrhea
- Hyperpigmentation
- Labs
- Hyponatremia
- Hyperkalemia
- Hypercalcemia
- Mild metabolic acidosis
- Hypoglycemia
- Causes
- Secondary
- Causes
- Iatrogenic (>5mg prednisone/day for > 2 weeks)
- Pituitary/sellar tumors
- Hemorrhage (Sheehan)
- Cranial radiation
- Signs/Symptoms
- RAAS function maintained, hypotension rare
- Features of pituitary/hypothalamic dysfunction: menstrual disturbances, headache, vision changes, galactorrhea, acromegaly
- Causes
- Adrenal Crisis
- Precipitated by physiologic stressor: sepsis, MI, trauma, surgery
- Diagnosis
- AM cortisol <3
- ACTH stimulation peak cortisol <15
- ACTH level
- Management
- Glucose management
- Fluid resuscitation
- Dexamethasone 10mg IV
- Identify and treat precipitant
- Primary
Cushing syndrome
- Causes
- Pituitary adenoma (Cushing disease)
- Malignancy (ACTH-producing): SCLC, pancreatic, carcinoid
- Adrenal neoplasm
- Signs/Symptoms
- Obesity, fat deposition in face, neck
- Skin atrophy with striae
- Proximal myopathy
- Hypertension
Pheochromocytoma
- Familial: MEN 2A/2B, NF, Von Hippel-Lindau
- Signs/Symptoms
- Refractory hypertension (paroxysmal)
- Heat intolerance, sweating, weight loss
- Diagnosis
- 24h urine metanephrine, catecholamine
- CT/MRI
Hypopituitarism
- Adenoma
- Symtoms/Signs
- Headache
- Vision changes (bitemporal hemianopsia)
- Cavernous sinus involvement (CN III, IV, V1, V2, VI)
- Symtoms/Signs
- Ischemic necrosis
- Sickle cell disease, vasculitis, cavernous sinus thrombosis, infection, TBI, post-partum (Sheehan)
- Pituitary apoplexy
- Acute loss of pituitary function from infection/hemorrhage, rarely tumor
- Symptoms/Signs
- Abrupt onset headache
- Vision changes
- Meningismus
- ALOC