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Podcast 505: Sleep on Strep Throat 

Emergency Medical Minute

Release Date: 10/01/2019

On the Streets #12: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord Part II show art On the Streets #12: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord Part II

Emergency Medical Minute

In this podcast, we are back again with host, Jordan Ourada, and neurosurgeon, Dr. Eddie Tsvankin as they discuss an exciting and mind-blowing array of topics pertaining to neurosurgery. Listen as Dr. Tsvankin shares his views on not only the history of neurosurgery, but also the medical, surgical, and engineering advancements that are taking place today. You’ll also hear Dr. Tsvankin give intriguing details into how neurosurgeries are performed with cutting-edge technology including the exoscopes that are presently utilized at Swedish Medical Center. Finally, Jordan and Dr. Tsvankin delve...

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Podcast 722: Lower Extremity Dislocations show art Podcast 722: Lower Extremity Dislocations

Emergency Medical Minute

Contributor: Donald Stader, MD Educational Pearls: Hip Dislocation Prolonged dislocations can impair blood supply to femoral head Hip dislocation for >6 hours puts patient at high risk for needing a hip replacement in the next two year Knee Dislocation High mechanism Often looks anatomically normal on knee x-ray Vascular injuries of the popliteal artery can cause significant morbidity with some studies suggesting an 80% amputation rate if not treated within 6 hours Ankle Dislocation Common dislocation and often co-occurs with ankle fractures (bimalleolar/trimalleolar) Pressure on...

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Podcast 721: Blakemore & Minnesota Tubes: Part II show art Podcast 721: Blakemore & Minnesota Tubes: Part II

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: To place a Blakemore/Minnesota Tube: Insert into esophagus under visualization Inflate gastric port with 60 cc of air and obtain a chest xray to ensure the balloon below the diaphragm Once confirmed, place a total of 500cc of air into the gastric balloon via the gastric port Tie a liter saline bad to the tube using Kerlix and hang it off an IV pole or other object to provide about 2 lbs of traction Now the the tube is in place under traction, attach a manometer to the esophageal balloon port Provide low pressure to tamponade a variceal...

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On the Streets #11: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord show art On the Streets #11: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord

Emergency Medical Minute

On this episode of On The Streets, host, Jordan Ourada sits down with neurosurgeon/neurooncologist Dr. Eddie Tsvankin to discuss various topics concerning neurosurgery and how EMS workers in the field can better understand and manage neurological emergencies. In this episode specifically, you’ll hear Jordan and Dr. Tsvankin discuss topics including: Priorities in caring for patients experiencing seizures Short and long-term complications of tumor resection surgery Specifics on how brain tumors are operated on and the difficult decisions that must be made ahead of time Assessment of...

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Podcast 720: Blakemore & Minnesota Tubes: Part I show art Podcast 720: Blakemore & Minnesota Tubes: Part I

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: Minnesota Tube has an extra port for suctioning otherwise is the same as a Blakemore Tube Indicated in MASSIVE upper GI bleeding often due to esophageal varices Esophageal varices are dilated, tortuous vessels in the esophagus due to increased portal venous pressure that can bleeding into the upper GI tract Patients with massive upper GI bleed should be intubated prior to placing a Blakemore/Minnesota tube References Meseeha M, Attia M. Esophageal Varices. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls...

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Podcast 719: Normal Saline vs. Tap Water for Wound Irrigation show art Podcast 719: Normal Saline vs. Tap Water for Wound Irrigation

Emergency Medical Minute

Contributor: Ricky Dhaliwal, MD Educational Pearls: Multiple RCTs and a Cochrane Review found there is no difference in wound infection rates when irrigating with tap water  Pressure of the water and how extensively the wound is irrigated were the most important factors affecting infection rates Quantity and type of water were independently not as important References Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2012;(2):CD003861. Published 2012 Feb 15. doi:10.1002/14651858.CD003861.pub3 Lewis K, Pay JL. Wound Irrigation. [Updated 2021 Jun 4]. In:...

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Podcast 718: Renal Failure Follow Up show art Podcast 718: Renal Failure Follow Up

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Patients with acute renal failure often need medical management for hyperkalemia Those with severe electrolyte derangements or absent renal function may need emergent dialysis as well Dialysis catheters are 12 or 14 french catheters placed in the right internal jugular or left subclavian Placement is very similar to a central line or cordis catheter Trialysis catheter is one option that has an extra port that can be used for regular medication administration and drawing blood Do not default to use dialysis catheters for normal ED access due to...

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Podcast 717: A cautionary tale of renal failure show art Podcast 717: A cautionary tale of renal failure

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia can cause EKG changes such as a widened QRS The fastest electrolyte results can be obtained off a VBG with electrolytes  or point-of-care labs Hyperkalemia may be reported as “hemolyzed” which indicated lysis of red blood cells and artificial elevation of the potassium level. However, always keep in mind the clinical context and look at other metabolic abnormalities like creatinine and BUN for other clues that it may actually not be hemolyzed References Co I, Gunnerson K. Emergency Department Management of Acute Kidney...

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Podcast 716: Resuscitation Fluids show art Podcast 716: Resuscitation Fluids

Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Fluid choice may have an impact on outcomes in resuscitation, and a meta-analysis has relevant insight into their use in sepsis and trauma patients Large volume normal saline fluid resuscitation in sepsis is associated with acute kidney injury and metabolic acidosis compared to Lactated Ringers Choice of fluid did not have significant differences in trauma patients for initial resuscitation References Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu YK. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and...

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Podcast 715: Heated High Flow O2 show art Podcast 715: Heated High Flow O2

Emergency Medical Minute

Contributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or “heated high flow” can deliver higher oxygen levels than nasal cannula It typically is used as an “intermediate” between oxygen via nasal cannula and other non-invasive positive pressure devices, such as BiPAP Can modify both the FiO2 and flow rate Maximum flow rate is typically  60 liters per minute (compare that to a typical breath that is 30-40 L/min) Humidification of HFNC is important due to risk of epistaxis from drying out the nasal mucosa Large energy expenditure to humidify airflow by a...

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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