Podcast 853: Critical Care Medications - Vasopressors
Emergency Medical Minute
Contributor: Travis Barlock MD Educational Pearls: Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators Inopressors: Epinephrine - nonselective beta- and alpha-adrenergic agonism, leading to increased cardiac contractility, chronotropy (increased heart rate), and peripheral vasoconstriction. Dose 0.1mcg/kg/min. Levophed (norepinephrine) - more vasoconstriction peripherally than inotropy; useful in most cases of shock. Dose 0.1mcg/kg/min. Peripheral vasoconstrictors: Phenylephrine - pure alpha agonist; useful in atrial fibrillation because it...
info_outline
Podcast 852: Angioedema After Thrombolysis
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: What is thrombolysis? Thrombolysis is performed by administration of a medication that promotes the body’s natural ability to break up clots. These medications include Alteplase (tPA) and Tenecteplase (TNK). The main side effect of using such an agent is bleeding which typically occurs at puncture sites but can also occur internally. However, an unusual side effect of thrombolytic agents, which occurs in about 1-5% of cases, is angioedema. What is angioedema? Angioedema is a medical condition that causes swelling beneath the surface...
info_outline
Podcast 851: High-Dose Nitroglycerin in SCAPE
Emergency Medical Minute
Contributor: Aaron Lessen MD Educational Pearls: SCAPE (Sympathetic Crashing Acute Pulmonary Edema), formerly known as flash pulmonary edema, is a life-threatening condition due to a sudden sympathetic surge that leads to hypertensive heart failure, pulmonary edema, hypoxia, and respiratory distress. The initial treatment for SCAPE stabilization is BiPAP to assist with ventilation. Pharmacological treatment for SCAPE is best achieved with high-dose nitroglycerin (HDN), which induces venodilation and redistributes pulmonary edema. Dosing should be high; boluses of HDN are given at...
info_outline
Podcast 850: Cardiac Arrest - Entertainment vs. Reality
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: Sudden Cardiac Arrest (SCA) is defined as when the heart suddenly stops beating. Immediate treatment for SCA includes Cardiopulmonary Resuscitation (CPR) and defibrillation. This event is commonly depicted in medical dramas as an intense moment but often with the patient surviving and making a full recovery (67-75%). This depiction has likely led the general population astray when it comes to the true survivability of SCA. When surveyed, the general population tends to believe that in excess of 50% of patients requiring CPR survive and return...
info_outline
Mental Health Monthly #15: Psychosis in the ED: Part I
Emergency Medical Minute
Contributors: Andrew White MD & Travis Barlock MD In this episode of Mental Health Monthly, Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency physician at Swedish Medical Center, discuss the various presentations and etiologies of acute psychosis. They explore the medical presentations compared with primary psychiatric manifestations and how to narrow the differential. Furthermore, Dr. Barlock discusses the management of psychotic patients from the ED perspective while Dr. White provides invaluable insight into their...
info_outline
Podcast 849: Large Vessel Occlusions
Emergency Medical Minute
Contributor: Travis Barlock MD Educational Pearls: Large Vessel Occlusion (LVO) is a condition where a clot blocks one of the major blood vessels in the brain, leading to a stroke. What are the vessels that can experience an LVO? Middle Cerebral artery (MCA) Internal Carotid Artery (ICA) Anterior Cerebral Artery (ACA) Posterior Cerebral Arteries (PCA) Basilar Artery (BA) Vertebral Arteries (VA) What are the locations at which a mechanical thrombectomy can be performed as a treatment for an LVO? Distal ICA, M1 or M2 segments of the MCA, A1 or A2 segments of the ACA, and some evidence for...
info_outline
Podcast 848: Non-Traditional RSI
Emergency Medical Minute
Contributor: Meghan Hurley, MD Educational Pearls: Two main reasons to choose non-traditional RSI Anatomically challenging airway Physiologically difficult patients: hypoxia, metabolic acidosis, hemodynamic instability Ketamine may help patients remain hemodynamically stable In critical patients, it is important to consider non-traditional RSI medications to improve outcomes References 1. Lyon RM, Perkins ZB, Chatterjee D, Lockey DJ, Russell MQ. Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma...
info_outline
Podcast 847: ECMO CPR
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Extracorporeal Membrane Oxygenation (ECMO) has been attempted as an adjunct to CPR during cardiac arrest but few studies on outcomes exist One prior small study stopped early when it showed ECMO with CPR (ECPR) was significantly superior to CPR Recent large, multicenter randomized control study in Netherlands evaluated neurologic outcomes in CPR versus ECPR At 30 days and 6 months no significant difference between the groups was found More studies are required determine if certain patients may benefit from ECPR References...
info_outline
Podcast 846: Early Repolarization vs. Anterior STEMI
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: Early repolarization a benign EKG pattern that can mimic an anterior STEMI Can be seen in the anterior leads typically in young male patients Can differentiate Early Repolarization vs Anterior STEMI by looking at four variables: Corrected QT interval QRS amplitude in V2 R wave amplitude in V4 ST elevation 60 ms after J point in V3 These four variables can be plugged into a formula (available on MDCalc) Note that a longer QT is more corelated with STEMI References Macfarlane PW, Antzelevitch C, Haissaguerre M, et al. The Early...
info_outline
Podcast 845: Hyperkalemic Cardiac Arrest
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia may cause cardiac arrest Treatment of suspected hyperkalemic cardiac arrest begins with typical management of cardiac arrest including high-quality CPR, defibrillation if appropriate, and resuscitation medications Administer calcium products to stabilize cardiac membrane and potassium shifting medications If ROSC is achieved, initiate dialysis There are several case reports of patients being dialyzed while CPR is ongoing, with some success Dialysis during resuscitation may be an appropriate...
info_outlineContributor: Aaron Lessen, MD
Educational Pearls:
- Insulin pumps provide a continuous infusion of fast-acting insulin using a basal rate and bolus prior to meals
- Some connect to a continuous glucometer but often blood glucose needs to be checked manually
- Hypoglycemia is rarely due to a malfunctioning pump - there is usually an another external factor
- Hyperglycemia can be caused by underdosing, illness, pump malfunction or expired insulin
- The pump can be used to give a bolus of insulin in the emergency department if necessary
- Stopping the device can be done manually on the device or disconnecting it from the tubing attachment - do not remove the tubing from the skin site if possible
References
Nimri R, Nir J, Phillip M. Insulin Pump Therapy. Am J Ther. 2020;27(1):e30-e41. doi:10.1097/MJT.0000000000001097
Sora ND, Shashpal F, Bond EA, Jenkins AJ. Insulin Pumps: Review of Technological Advancement in Diabetes Management. Am J Med Sci. 2019;358(5):326-331. doi:10.1016/j.amjms.2019.08.008
Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.