EM Quick Hits 19 Angioedema, SAH Decision Tool, Breastfeeding Myths, COVID-19 Neurology, Spider Bites, Skin Abscess Management

Topics in this EM Quick Hits podcast

Anand Swaminathan on airway management in angioedema (1:15)

 Jeff Perry on Ottawa subarachnoid hemorrhage rule and 6hr CT rule (8:42)

Hania Bielawska on ED breastfeeding myths and misconceptions (21:16)

Rachel Bridwell, Brit Long & Michael Gottlieb on neurologic associations with COVID-19 (29:53)

Justin Hensley on management of spider bites (36:06)

Hans Rosenberg & Heather Murray on management of skin abscesses (44:52)





Podcast production, editing and sound design by Anton Helman

Podcast content, written summary & blog post by Anand Swaminathan, Brit Ling, Hania Bielawska and Anton Helman.

Edited by Anton Helman

Cite this podcast as: Helman, A. Swaminathan, A. Perry, J. Rosenberg, H. Bielawska, H, Long, B. Bridwell, R. Gottlieb M. Hensley, J. Murray, H. EM Quick Hits 19 Angioedema, SAH Decision Tool, Breastfeeding Myths, COVID-19 Neurology, Spider Bites, Skin Abscess Management. June, 2020. https://emergencymedicinecases.com/em-quick-hits-june-2020/. Accessed [date].

Management of Severe Angioedema



* For the crashing patient with severe angioedema consider a Ketamine-Only Breathing Intubation (see KOBI), an alternative to awake intubation using dissociative dose ketamine (in a typical adult 100 mg over 30 seconds), and have a "double set up" with the neck prepared for cricothyrotomy

* For the non-crashing patient with severe angioedema consider an awake intubation with full topicalization and fiberoptic intubation

* Medications for ACEi-associated angioedema such as icatibant, C1 esterase inhibitors and FFP are not evidence based and are generally not indicated

* Consider tranexamic acid (TXA) 1g IV over 10 minutes based on a study of 33 patients in France



Episode 127 - Drugs that work and drugs that don't - Is there any role for icatibant, C1 esterase inhibitors or FFP for angioedema?

Expand to view reference list



* Beauchêne C, Martins-héricher J, Denis D, Martin L, Maillard H. [Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors]. Rev Med Interne. 2018;39(10):772-776.



Ottawa Subarachnoid Hemorrhage Rule and 6-Hour Computed Tomography Rule

The Ottawa SAH rule is recommended to assess whether or not a patient who presents with headache can be safely ruled out without any investigations.

Inclusion: GCS 15,  ≥15 years old, new severe atraumatic headache, maximum intensity within 1 hour.

Exclusion: Patients with new neurologic deficits, prior aneurysm, prior SAH, known brain tumors, or chronic recurrent headaches (≥3 headaches of the same character and intensity for >6 months).





* Age ≥40,

* Neck pain or stiffness,

* Witnessed loss of consciousness,

* Onset during exertion,

* Thunderclap headache (peaking pain within 1 second),

* Limited neck flexion on examination



The Ottawa SAH rule was shown to have a 100% sensitivity for SAH in its va...