loader from loading.io

Podcast 572:  Locked In Syndrome

Emergency Medical Minute

Release Date: 06/16/2020

Podcast 667: Lactated Ringers for DKA show art Podcast 667: Lactated Ringers for DKA

Emergency Medical Minute

Contributor:  Aaron Lessen, MD Educational Pearls: Recent study looked at whether lactated ringers might be a better choice for fluid resuscitation in patients with DKA compared to normal saline Normal saline can cause a hyperchloremic metabolic acidosis Time to resolution of acidosis was 4 hours less with lactated ringers compared to normal saline Time on an insulin drip decreased by about 4 hours with lactated ringers compared to normal saline LR might be a better choice for fluid resuscitation in patients with DKA References Self WH, Evans CS, Jenkins CA, et al. Clinical Effects of...

info_outline
Podcast 666: Pain Management & Patient Perspective    show art Podcast 666: Pain Management & Patient Perspective

Emergency Medical Minute

Contributor:  Jared Scott, MD Educational Pearls: About ½ of the patients in the ED present with some form of pain One study looked at patients presenting in pain and followed up two days after discharge to determine if their pain was addressed, asking if the patient received anything for pain and if the patient refused pain medication Non-analgesic pain management: About 30% discordance between patient reports and documentation Conventional analgesic pain management: About 15% discordance between patient reports and documentation References Taylor DM, Valentine S, Majer J, Grant N....

info_outline
Podcast 665: Allergic Reactions after COVID Vaccinations show art Podcast 665: Allergic Reactions after COVID Vaccinations

Emergency Medical Minute

Contributor:  Peter Bakes, MD Educational Pearls: Incidence 2.5-10 per million people occurring primarily in those with environmental allergens Typically occurs with mRNA vaccines in lipid nanoparticles (Moderna/Pfizer) rather than the adenovirus vaccine (J&J) Recommendation is to forego 2nd dose of the mRNA vaccine and instead get the adenovirus vaccine after weighing the risks and benefits References Kounis NG, Koniari I, de Gregorio C, Velissaris D, Petalas K, Brinia A, Assimakopoulos SF, Gogos C, Kouni SN, Kounis GN, Calogiuri G, Hung MY. Allergic Reactions to Current Available...

info_outline
Podcast 664: Rabies Prophylaxis show art Podcast 664: Rabies Prophylaxis

Emergency Medical Minute

Contributor:  Jared Scott, MD Educational Pearls: 1-3 cases of rabies per year in US with 55,000 people per year receiving rabies prophylaxis 90% of rabies cases come from wildlife, most commonly by racoons, bats, foxes, and skunks Because of rabies prophylaxis, domesticated pets almost never have rabies in the United States Rabies is typical transmitted via a bite, but direct contact with saliva or brain tissue on an open wound can transmit the virus Some people exposed to rabies from bats will never report a bite References Kessels J, Tarantola A, Salahuddin N, Blumberg L, Knopf L....

info_outline
Podcast 663:  Down Syndrome show art Podcast 663:  Down Syndrome

Emergency Medical Minute

Contributor:  Alicia Oberle, MD Educational Pearls: Down Syndrome with Trisomy 21 have three copies of chromosome 21 Current birth rates are around 1 in 700 births  Average life span 25 years in 1980, today the average life span is 60 years of age Patients with Down syndrome require additional therapies in the first 3 years due to developmental delays They also have increased risk for childhood leukemias, seizures, hypothyroidism, celiac disease, and early-onset Alzheimers Half have a cardiac defect requiring surgery at birth References Tsou AY, Bulova P, Capone G, et al. Medical...

info_outline
UnfilterED #13: Dr. Nadia Tremonti show art UnfilterED #13: Dr. Nadia Tremonti

Emergency Medical Minute

This week’s episode features a fascinating conversation with Dr. Nadia Tremonti, medical director for the pediatric palliative care program at Children’s Hospital of Michigan in Detroit. Dr. Tremonti was the featured physician in an independent short film Palliative and subsequent New York Times shorter excerpt Dying in your Mother’s Arms that explore her work with terminally ill pediatric patients. From conversations of religion’s role in processing disease to the physician’s role in alleviating suffering for patients and their families, Nick and Nadia explore the existential ground...

info_outline
Podcast 662: Droperidol for Sedation show art Podcast 662: Droperidol for Sedation

Emergency Medical Minute

Contributor:  Aaron Lessen, MD Educational Pearls: Droperidol for sedation in agitated patients in the emergency department was studied compared to ziprasidone (Geodon) and lorazepam (Ativan) Double-blinded RCT showed droperidol was 65% effective to get patients to a good level of sedation in 15 minutes compared to ativan and geodon which were 25-35% effective Droperidol had less respiratory depression and prolongation of the QT compared to Ativan and Geodon References Martel ML, Driver BE, Miner JR, Biros MH, Cole JB. Randomized Double-blind Trial of Intramuscular Droperidol,...

info_outline
Podcast 661: Scalded Skin Syndrome show art Podcast 661: Scalded Skin Syndrome

Emergency Medical Minute

Contributor:  Ricky Dhaliwal, MD Educational Pearls: Primarily affects children <6 years old and adults with kidney disease Caused by staph aureus releasing exotoxins that result in erythema and sloughing of the skin Present with significant pain, dehydration and underlying staph infection Treatment typically oxacillin/nafcillin with admission for wound care with petroleum gel and xeroform Burn centers may be treatment centers of choice for this condition Most patients recover in 2-3 days with treatment References Patel GK, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis...

info_outline
Podcast 660: Rhabdomyolysis show art Podcast 660: Rhabdomyolysis

Emergency Medical Minute

Contributor:  Ricky Dhaliwal, MD Educational Pearls: Rhabdomyolysis occurs when high levels of myoglobin are released from dying muscle tissue into the blood Severe levels of myoglobin cause renal injury Causes include elevated temperature, excessive exercise, toxins, infection, muscle ischemia, crush injury, and prolonged immobilization Can also be caused by medications, like antipsychotics, statins, SSRIs, colchicine, lithium Workup typically includes  creatinine kinase, potassium, creatinine levels and serial EKGs Firstline treatment is with  IV fluids with a goal urine...

info_outline
Podcast 659: Racial Bias in Pulse Oximetry show art Podcast 659: Racial Bias in Pulse Oximetry

Emergency Medical Minute

Contributor:  Aaron Lessen, MD Educational Pearls: Study in NEJM looked at occult hypoxemia, when oxygen saturation reads at >92% when the actual saturation is <88% Rate of occult hypoxemia was 3 times higher in those who identified as black (12% vs 4%) Keep this disparity in mind when providing care to patients of all backgrounds and incorporate into clinical decision-making References Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. 2020;383(25):2477-2478. doi:10.1056/NEJMc2029240 Summarized by John Spartz, MS3 |...

info_outline
 
More Episodes

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Locked in syndrome results typically from an infarct of the basilar artery leading to infarction of the brainstem but typically preservation of the higher structures
  • The result is complete paralysis with preserved cognitive function, hence the name
  • Because of their location within the brainstem, ocular movements are sometimes preserved, allowing a patient who recovers from the initial injury to communicate
  • Patients typically do not regain any motor function and have a poor prognosis of recovery
  • Thrombectomy of the basilar artery is sometimes considered even late after the initial presentation given the devastating prognosis

References

Smith E, Delargy M. Locked-in syndrome. BMJ. 2005;330(7488):406‐409. doi:10.1136/bmj.330.7488.406

Buchman SL, Merkler AE. Basilar Artery Occlusion: Diagnosis and Acute Treatment. Curr Treat Options Neurol. 2019;21(10):45. Published 2019 Sep 26. doi:10.1007/s11940-019-0591-0

Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, et alMechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulationJournal of NeuroInterventional Surgery 2019;11:1174-1180.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD