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Podcast 505: Sleep on Strep Throat 

Emergency Medical Minute

Release Date: 10/01/2019

Podcast 517: It’s all about the PEEP  show art Podcast 517: It’s all about the PEEP 

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: Bag-valve masks (BVM) typically  have a port to connect O2 to. Unfortunately room air becomes entrained in the mask, reducing the FiO2 delivered to the patient. This can be overcome by using a PEEP (positive end-expiratory pressure) valve on the BMV  PEEP valves function by keeping alveoli open in the lungs at the end of expiration. This increases the oxygen diffusing ability of the lungs, keeping patients’ oxygen saturations higher.  Patients who are critically ill can become quickly hypoxic after RSI meds due to reduced...

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UnfilterED #2: Lisa Raville & Dr. Josh Blum show art UnfilterED #2: Lisa Raville & Dr. Josh Blum

Emergency Medical Minute

Lisa Raville and Dr. Josh Blum, two pioneers of harm reduction in Denver, discuss the addiction crisis, the current state of harm reduction and how it will evolve in the future.   Intro Music: Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

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Podcast 516: Narcan and Pulmonary Edema show art Podcast 516: Narcan and Pulmonary Edema

Emergency Medical Minute

Contributor: Erik Verzemnieks, MD Educational Pearls: Important to realize complications can occur in the post-opioid overdose patient regardless of cause Narcan administration has been associated with non-cardiogenic pulmonary edema, although the mechanism of this is not quite known Symptoms include progressive shortness of breath and hypoxia.  Treatment is with positive-pressure ventilation and diuresis, similar to cardiogenic causes Though rare, it would appear this typically resolves with treatment   Reference  Jiwa N, Sheth H, Silverman R. Naloxone-Induced...

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Podcast 515: Non-Accidental Trauma  show art Podcast 515: Non-Accidental Trauma 

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Non-accidental trauma (NAT) to children is commonly missed by medical providers Try to remember TEN-4-FACES as a useful aide for concerning patterns that may reflect NAT: Torso, ears, neck and any bruising in child 4 months or longer Frenulum, angle of the mandible, cheek, eyes, sclera References Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT. The Prevalence of Bruising Among Infants in Pediatric Emergency Departments. Ann Emerg Med. 2016 Jan;67(1):1-8. PMID: 26233923.  Pierce MC, Kaczor K, Aldridge S,...

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Podcast 514: Pain Control While on Naltrexone  show art Podcast 514: Pain Control While on Naltrexone 

Emergency Medical Minute

Author: Don Stader, MD Educational Pearls: Suboxone, methadone, and naltrexone are commonly used as treatments for opiate use disorder.  Naltrexone is a full mu-opiate receptor antagonist, making acute pain control difficult in patients taking it.  Options for pain control in patients on naltrexone include nerve blocks, NSAIDS, ketamine, and high doses of opiates.  Of the opiates, Dilaudid (hydromorphone) has the highest affinity for mu-opiate receptors, and will be the most effective. References Vickers AP, Jolly A. Naltrexone and problems in pain management. BMJ....

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Podcast 513: Plague show art Podcast 513: Plague

Emergency Medical Minute

Author: John Winkler, MD Educational Pearls: The plague (black death) is caused by the Yersinia Pestis bacteria. This bacteria is spread by fleas and carried by rats. It is very contagious and only needs ~ 100 bacteria to cause an infection.  The pulmonary form presents with cough, fever, night sweats, hemoptysis and has a near 100% fatality rate if not treated in the first day of symptoms The bubonic form causes buboes, which are necrotic, purulent lymph nodes that can lead to sepsis.  Prairie dogs are a common carrier in modern times References...

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Podcast 512: Abstinence is Bad, mmmkay? show art Podcast 512: Abstinence is Bad, mmmkay?

Emergency Medical Minute

Author: Don Stader, MD Educational Pearls: Abstinence from substances such as tobacco or alcohol are effective strategies to achieve long term sobriety However, abstinence is not an effective strategy for achieving sobriety with opiate use disorder (OUD) Up to 90% of those who use an abstinence-only strategy for OUD will relapse within a month.  Attending a rehabilitation facility increases mortality in those with OUD due to decreased tolerance and higher rates of overdose.  Medication-assisted therapy (MAT) with naltrexone, buprenorphine or methadone for OUD is supported by...

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Podcast 511: Ebola Treatment  show art Podcast 511: Ebola Treatment 

Emergency Medical Minute

Author: Rachel Beham, PharmD Educational Pearls: There are currently many Ebola vaccines that are being studied, and one (recombinant VZV-Ebola vaccine) is currently being used in Africa. This vaccine has so far shown good efficacy in reducing Ebola infections and mortality from Ebola in those who do become infected.  There are antibody-based treatments that are currently under investigation for the treatment of Ebola. They have been well tolerated in phase 1 trials and show some promise of efficacy.   References Shcheblyakov D et. al. Development and characterization of two...

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Podcast # 510: Ebola show art Podcast # 510: Ebola

Emergency Medical Minute

Author: John Winkler, MD Educational Pearls: There is a new outbreak of Ebola in The Congo. This is likely due to civil war and rebel attacks on healthcare workers in the area.  Ebola is now spreading from the Congo into neighboring Uganda, but vaccination efforts are staving off the spread across the border  Early symptoms of Ebola are similar to the flu Spread occurs through close contact with bodily fluids. Proper PPE is required when treating patients with suspected ebola  References https://wwwnc.cdc.gov/travel/notices/alert/ebola-democratic-republic-of-the-congo...

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Podcast 509: Circadian Rhythm and Shift Work, From Z to Z show art Podcast 509: Circadian Rhythm and Shift Work, From Z to Z

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Sleep deprivation and disturbed sleep cycles increases the risk of many acute and chronic medical issues such as motor vehicle accidents, diabetes, cardiovascular disease, psychiatric disease,  and shift work sleep disorder (difficulty sleeping, fatigue, interference with daily activities) Stages of sleep  Stage 1: 5-10 minutes (light sleep, may not recognize).  Stage 2: Spindle waves, mostly unstudied  Stage 3: Restorative sleep Stage 4 (REM): Paralysis, memory consolidation One sleep cycle takes about 120 minutes Light...

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More Episodes

Contributor: Don Stader, MD

Educational Pearls:

  • Only 10% of patients receiving antibiotics for strep throat actually have the diesease
  • Treatment of strep with antibiotics only slightly reduces the duration of illness. Most studies say the reduction is between 16 and 24 hours
  • Antibiotic treatment may reduce complications such as peritonsilar abscess and otitis media but antibiotics also increase the risk of diarrhea and yeast infection
  • Rheumatic fever is caused by a specific serotype of strep that is no longer prevalent in the United States, so treating strep throat likely has no effect on preventing this complication 

References

Anand Swaminathan, "Do Patients with Strep Throat Need to Be Treated with Antibiotics?", REBEL EM blog, January 5, 2015. Available at: https://rebelem.com/patients-strep-throat-need-treated-antibiotics/. 

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD