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

Emergency Medical Minute

Release Date: 10/11/2021

Podcast 736: Seasonal Affective Disorder show art Podcast 736: Seasonal Affective Disorder

Emergency Medical Minute

Contributor: Adam Barkin, MD Educational Pearls: Seasonal Affective Disorder (SAD) a form of seasonal depression which can result in trouble sleeping, concentration difficulties, changes in appetite, and decreased mood SAD is a common condition affecting millions of people in the US Coupling this with the stresses of COVID, these affects may be compounded To reduce the effects of SAD: Stick to a routine Exercise Light therapy Engage with your community Meditation Tangible bucket list to set goals for the winter Nostalgic activity References Melrose S. Seasonal Affective Disorder: An...

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Podcast 735: End Tidal CO2 and BiPAP show art Podcast 735: End Tidal CO2 and BiPAP

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: End tidal CO2 is accurate to 1-4 mmHg in intubated patient but use with those on positive pressure ventilation like BiPAP is unclear Study looked at patients on BiPAP for COPD or CHF and found end tidal CO2 measurements were significantly underestimated when compared to VBG levels End tidal CO2 measurements for those on positive pressure ventilation appears to be inaccurate References Uzunay H, Selvi F, Bedel C, Karakoyun OF. Comparison of ETCO2 Value and Blood Gas PCO2 Value of Patients Receiving Non-invasive Mechanical Ventilation Treatment...

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Podcast 734: Push Dose Antibiotics show art Podcast 734: Push Dose Antibiotics

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Recent study at a hospital in Chicago with a shortage of normal saline decided to push IV ceftriaxone rather than the typical infusion of the antibiotic Retrospective chart analysis of about 800 patients to determine safety of giving a push dose of ceftriaxone Only 1 complication due to the ceftriaxone causing a patient to vomit References Agunbiade A, Routsolias JC, Rizvanolli L, Bleifuss W, Sundaresan S, Moskoff J. The effects of ceftriaxone by intravenous push on adverse drug reactions in the emergency department. Am J Emerg Med....

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Podcast 733: Nitric Oxide for COVID show art Podcast 733: Nitric Oxide for COVID

Emergency Medical Minute

Contributor: Nick Hatch, MD Educational Pearls: Inhaled nitric oxide or Flolan may be considered in COVID Flolan is a prostaglandin can be inhaled or given IV These medications are classically used for right-sided heart failure, but may be used in COVID Causes pulmonary vasodilation to reduce the resistance against the right ventricle Complications include hypotension and hemolysis, but nitric oxide can be turned off very quickly if needed Be careful and wean patients on nitric oxide for pulmonary hypertension References Lotz C, Muellenbach RM, Meybohm P, et al. Effects of inhaled...

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Podcast 732: Organophosphate Toxicity show art Podcast 732: Organophosphate Toxicity

Emergency Medical Minute

Educational Pearls: Organophosphates affect the cholinergic system by inhibiting acetylcholinesterase affecting muscarinic and nicotinic receptors Symptoms include lacrimation, salivation, bronchoconstriction, blurred vision, bradycardia, bronchorrhea, emesis, and diarrhea Initially, the patient should be decontaminated to prevent further organophosphate exposure Treatment consists of atropine every 5 minutes, 1-3 mg to start and doubling the dose each time it is given until reversal of symptoms is seen Atropine only works on muscarinic receptors, so nicotinic receptor activation continues...

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Podcast 731: Fluid Resuscitation in Burns show art Podcast 731: Fluid Resuscitation in Burns

Emergency Medical Minute

Contributor: Chris Holmes, MD Educational Pearls: Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the next 16 hours Brooke Formula: 2 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the next 16 hours 2009 military study evaluated Parkland vs. Brooke formulas for severe burn patients and found the outcomes were the same Guidelines are in flux on which formula to use, but reducing the overall volume using the Brooke...

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Podcast 730: Alternative Treatment for Gonorrhea show art Podcast 730: Alternative Treatment for Gonorrhea

Emergency Medical Minute

Educational Pearls: Recent updates to treatment guidelines increased the 250 mg ceftriaxone IM dose to 500 mg ceftriaxone IM IM dosing can be very painful, so other methods of administration can help decrease pain for patients Using IV ceftriaxone instead of IM has no significant difference in pharmacokinetics or bioavailability, so it can be considered in patients with an IV already placed References St Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50):1911-1916. Published 2020 Dec 18....

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Podcast 729: Molnupiravir for COVID show art Podcast 729: Molnupiravir for COVID

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: A press release from Merck introduced Molnupiravir for treatment of mild to moderate COVID-19 The yet to be published study is a randomized control trial at around 100 different sites Reported outcomes were hospitalization and mortality from COVID and mortality from COVID Molnupiravir was found to be twice as effective as placebo looking at these two endpoints (7% vs. 14%) 5 day course of the drug taken twice per day costs $700, but cost-saved from using this drug was $32,000 per patient References ...

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Podcast 728: Angiography for Out-of-Hospital Cardiac Arrest without ST Elevation show art Podcast 728: Angiography for Out-of-Hospital Cardiac Arrest without ST Elevation

Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Meaningful survival under 10% for out of hospital cardiac arrest The most common cause of out-of-hospital cardiac arrest is due to cardiac ischemia Study looked at whether taking patients without ST elevation who had an out-of-hospital cardiac arrest with return of spontaneous circulation (ROSC) should receive angiography upon arrival to the hospital Took 530 patients and randomized to early vs. delayed angiography after resuscitation from out-of-hospital arrest Found no benefit to early angiography using 30-day all-cause risk of death as the...

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Podcast 727: Antibiotics for Diverticulitis show art Podcast 727: Antibiotics for Diverticulitis

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Classically, diverticulitis is diagnosed via CT scan and patients are discharged home on antibiotics if they are without complication The DINAMO study is a multicenter open-label RCT that evaluated if it is safe to not give antibiotics to patients with mild acute diverticulitis Found no difference in readmission, return visits to ED, pain control, or likelihood of surgical intervention between the group that was sent home with antibiotics and the group without Medical societies have not reached a consensus on this issue, likely further studies...

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More Episodes

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: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538522/

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

 

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