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Podcast 766: Truth about Tramadol

Emergency Medical Minute

Release Date: 03/22/2022

Podcast 853: Critical Care Medications - Vasopressors show art 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...

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Podcast 852: Angioedema After Thrombolysis show art 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...

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Podcast 851: High-Dose Nitroglycerin in SCAPE show art 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...

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Podcast 850: Cardiac Arrest - Entertainment vs. Reality show art 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...

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Mental Health Monthly #15: Psychosis in the ED: Part I show art 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...

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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...

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Podcast 848: Non-Traditional RSI show art 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...

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Podcast 847: ECMO CPR show art 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...

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Podcast 846: Early Repolarization vs. Anterior STEMI show art 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...

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Podcast 845: Hyperkalemic Cardiac Arrest show art 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...

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More Episodes

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Tramadol is often thought of as a mild-opiate to use for analgesia, but it is a more complicated drug
  • Tramadol needs to be metabolized into an effective drug making it not pharmacologically reliable
    • 3-10% of people cannot metabolize tramadol and it does not work
    • Some others over-metabolize tramadol and it causes greater effect
  • Studies have shown it is not any better as a acetaminophen or ibuprofen for analgesia, it can lower a seizure threshold, and it acts to inhibit serotonin reuptake
  • Recent study evaluated all-cause mortality of tramadol compared to codeine and found tramadol had nearly double the all-cause mortality as those prescribed codeine
  • Overall tramadol has many risks and should be critically evaluated before prescribing

References

Dhesi M, Maldonado KA, Maani CV. Tramadol. [Updated 2021 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537060/

Association of tramadol vs codeine prescription dispensation with mortality and other adverse clinical outcomes Xie J, Strauss VY, Martinez-Laguna D, et al. JAMA. 2021;326(15):1504-1515.

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

 

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