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Podcast 572:  Locked In Syndrome

Emergency Medical Minute

Release Date: 06/16/2020

Podcast 643: Convulsions with Gastroenteritis show art Podcast 643: Convulsions with Gastroenteritis

Emergency Medical Minute

Contributor:  Jared Scott, MD Educational Pearls: Differential Diagnosis: non-accidental trauma, febrile seizure, meningitis, hyponatremia, epilepsy Convulsions with gastroenteritis is a known entity to cause seizures in infancy Predominantly occurs in ages 6 months to 3 years Occur with diarrheal episodes No electrolyte abnormalities associated with the seizure nor severe dehydration Seizures tend to come in clusters Most have a normal EEG and do not develop epilepsy Reported incidence in gastroenteritis of 1-2% of gastroenteritis Treatment addresses the seizures but long term...

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Podcast 642: Vasopressors show art Podcast 642: Vasopressors

Emergency Medical Minute

  Contributor:  Nick Tsipis, MD Educational Pearls: Epinephrine: alpha-1, alpha-2, beta-1, and beta 2 agonist - used in cardiac arrest with positive effects on ROSC in prehospital and peri-hopsital setting Norepinephrine: alpha-1 and beta-1 agonist - used in septic shock to increase cardiac output and peripheral vasoconstriction Phenylephrine: alpha-1 adrenergic agonist - used in spinal/neurogenic shock as well as medication-induced peri-procedural hypotension (propofol for RSI) as it only helps with vasoconstriction Dopamine: alpha-1, alpha-2, beta-1, beta 2, and dopamine agonist -...

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Podcast 641: Leadless Intracardiac Pacemaker show art Podcast 641: Leadless Intracardiac Pacemaker

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Small capsule pacemaker (2.5 cm, 1 ml volume) resides in the heart without any associated wires or leads like a traditional pacemaker The new version has a 6 year battery life, after which it can be deactivated and a traditional pacemaker put in place Cost is around 2-4 times that of a traditional pacemaker NEJM study from 2015 showed it met the primary efficacy endpoint in 90% of patients and the primary safety endpoint in 93.3% of patients Follow up study showed 3% complication with the intracardiac pacemaker compared to 9% in traditional ...

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Podcast 640: Kawasaki’s Disease show art Podcast 640: Kawasaki’s Disease

Emergency Medical Minute

Contributor: Peter Bakes , MD Educational Pearls: Pediatric Fever + Rash Differential: scarlet fever, measles, rubella, chicken pox, fifth’s disease, HHV-6, adenovirus, anaphylaxis, Kawasaki’s disease Kawasaki’s is diagnosed clinically with prolonged fever (>7 days fever in <6 months > 5 days of fever >6 months with 4 of the following:  Strawberry tongue/fissured lips Bilateral conjunctival injection Cervical lymphadenopathy Hand/foot edema Maculopapular rash Can develop life threatening coronary artery aneurysms Treated with aspirin/IVIG References Modesti AM,...

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Pharmacy Phriday #9: Xofluza (Baloxavir marboxil) for Influenza show art Pharmacy Phriday #9: Xofluza (Baloxavir marboxil) for Influenza

Emergency Medical Minute

Contributor: Rachael Duncan, PharmD BCPS Educational Pearls:  According to the Department of Public Health and Environment who puts out a weekly report on the influenza virus in Colorado, there appears to be less influenza in Colorado than previous years  A milder influenza outbreak is likely due to mask wearing and social distancing practices  There have only been 22 hospitalizations for influenza in Colorado since the start of the flu season back in September and 0 outbreaks in long-term care facilities  Xofluza (baloxavir marboxil) is an antiviral PA endonuclease...

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Mental Health Monthly #7: Urine Toxicology in the ED show art Mental Health Monthly #7: Urine Toxicology in the ED

Emergency Medical Minute

This episode of Mental Health Monthly we will be discussing drugs screens in the Emergency Department with Dr. Justin Romano and Eddie Carillo. Dr. Justin Romano is a current psychiatry resident and Eddie Carillo is a licensed mental health therapist. Check out their podcast on all major podcast platforms. Shout out to Dr. Dave Marshall whose grand round presentation this was based on.  Key Points:  Try not to judge your patient based on the results of their drug screen  Drug screens are used a lot; they are not always accurate  Based on one study there was no significant...

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Podcast 639: Rib Fractures in the Elderly show art Podcast 639: Rib Fractures in the Elderly

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective review of 5,021 patients over 65 with 2 or more  rib fractures recently published 3577 (78 %) were admitted to non-ICU setting 1.1% of these patients had unexpected intubation or ICU transfer Findings raise questions regarding current guidelines for ICU admission in elderly patients with isolated rib fractures References Naar L, El Hechi MW, van Erp IA, Mashbari HNA, Fawley J, Parks JJ, Fagenholz PJ, King DR, Mendoza AE, Velmahos GC, Kaafarani HMA, Saillant NN. Isolated rib cage fractures in the elderly: Do all patients...

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Podcast 638: Pyogenic Liver Abscess show art Podcast 638: Pyogenic Liver Abscess

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Pyogenic liver abscesses can be caused by Intra-abdominal infection progressing to peritonitis which then drains into liver Bacteremia leading to hematogenous spead and seeding Local biliary infection with contiguous spread Patients typically present with signs of sepsis or septic shock and the abscess can be diagnosed using ultrasound or CT Treat with IV fluids, broad spectrum antibiotics, and consultation for drainage References Kurland JE, Brann OS. Pyogenic and amebic liver abscesses. Curr Gastroenterol Rep. 2004 Aug;6(4):273-9. doi:...

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Podcast 637: LSD show art Podcast 637: LSD

Emergency Medical Minute

Contributor: Katie Sprinkel, MD Educational Pearls: Commonly known as “acid,” LSD is seeing a resurgence in the population as a recreational hallucination Onset is about 30 minutes with peak pharmacologic effects at 2-4 hours, the drug’s half life is 3 hours resulting in some prolonged effects While there is not an significant addictive component of LSD, tolerance for LSD does occur and prolonged usage is associated with increased incidence of schizophreniform disorders Hallucinations and pseudo-hallucinations (sensory misperceptions) are typical of LSD intoxication, other common signs...

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Podcast 636: May-Thurner Syndrome show art Podcast 636: May-Thurner Syndrome

Emergency Medical Minute

Contributor: Sam Killian, MD Educational Pearls: iliac vein compression syndrome is also called May-Thurner Syndrome The left leg more frequently develops deep venous thrombosis (DVT) in part because about 1/4 of the population has May-Thurner May-Thurner syndrome anatomic variant results in a right iliac artery compresses the left iliac vein against the spine, which can promote DVT formation This is thought to be the cause of 2-3% of DVTs in patients seen in the ED and suspicion for this disease should increased in those with recurrent DVT Diagnosis is made with MRV/MRA and will typically...

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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