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Podcast 505: Sleep on Strep Throat 

Emergency Medical Minute

Release Date: 10/01/2019

On the Streets #1: The Art of the Handoff Report show art On the Streets #1: The Art of the Handoff Report

Emergency Medical Minute

EMM is proud to present the pilot episode of our new monthly series, “On the Streets”. This will be an informative podcast for all of our listeners, but this one was designed specifically for our EMS listeners.  Each month, we will consult medical experts on topics pertinent to prehospital care: Identifying a posterior circulation stroke in the field; Knowing when to do a 12-lead and what to look for; How to use capnography for a variety of datapoints; How to give an effective handoff report. And much much more... On our first episode, we are proud to welcome long-time friend of EMM,...

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Podcast 540:   Zyprexa  show art Podcast 540:   Zyprexa 

Emergency Medical Minute

Contributor:  Don Stader, MD Educational Pearls: Olanzapine (Zyprexa) is an atypical antipsychotic that can be used in a similar fashion to haloperidol for pain and nausea, including that with abdominal pain and headaches Olanzapine can be administered as an oral disolving tablets, intramuscular or intravenous injection Because Zyprexa is an atypical antipsychotic, it has a lower risk for tardive dyskinesia and akathisia  Olanzapine may cause transient rises in glucose and should be considered when contemplating use in a diabetic References Olanzapine for the prevention and...

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Podcast 539:  Coricidin Abuse show art Podcast 539:  Coricidin Abuse

Emergency Medical Minute

Contributor:  Rachel Beham, PharmD Educational Pearls: Coricidin HBP Cough & Cold (dextromethorphan and chlorpheniramine) is one of the more commonly abused over-the-counter medications Dextromethorphan, binds to multiple receptors, particularly at high doses Opioid receptors, causing respiratory depression, CNS depression NMDA receptors, causing agitation and hallucinations Serotonin-reuptake inhibition, which may lead to serotonin syndrome, especially when combined with other agents Dextromethorphan also contains bromide, which when chronically abused can lead to bromism...

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Podcast 538:  Low Maintenance Boxer’s Fracture show art Podcast 538:  Low Maintenance Boxer’s Fracture

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: A distal 5th metacarpal neck fracture is often referred to as a “boxer’s fracture” and a common fracture encountered in the emergency department Splinting with an ulnar gutter splint is the typical management of uncomplicated boxer’s fractures A recent study randomized patients to buddy taping or ulnar gutter splint for uncomplicated Boxer’s fractures. Similar functional and pain outcomes were found at follow-up, and those in the buddy taping group returned to work more quickly.   One limitation was nearly 20% of study...

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Podcast 537:  Thoughts on Cardiac Arrest show art Podcast 537:  Thoughts on Cardiac Arrest

Emergency Medical Minute

Contributor:  Don Stader, MD Educational Pearls: High-quality compressions are an essential, and probably one of the most important, part of cardiac arrest  Actual evidence for drugs in cardiac arrest included in ACLS are limited, including epinephrine, bicarbonate, amiodarone, etc. Early defibrillation for ventricular tachycardia (VT) or ventricular fibrillation (VF) has a plethora of supporting evidence Double-sequential defibrillation (nearly simultaneous defibrillation using 2 machines) may be considered for refractory dysrhythmias like VF tPA during a cardiac arrest can be...

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UnfilterED #4: Dr. Vivek Tayal show art UnfilterED #4: Dr. Vivek Tayal

Emergency Medical Minute

Dr. Vivek Tayal of Carolinas Medical Center, a pioneer of using ultrasound in the emergency department, reflects on his role in establishing ultrasound use in emergency medicine and much more!   Ultrasound Program Management:   Intro Music: Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

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Podcast 536:  Epistaxis 101 show art Podcast 536:  Epistaxis 101

Emergency Medical Minute

Contributor:  Dylan Luyten, MD Educational Pearls: Clear the nasal passages - have the patient, if stable, blow their nose to dislodge any clot that might be in the way Searching for the source of bleeding can be tough. Majority of anterior bleeding is from Kesselbach’s plexus Placing a clamp to provide direct pressure is a mainstay of treatment Application of a topical agent, which may include lidocaine epinephrine tetracaine (LET), tranexamic acid (TXA), or oxymetazoline Nasal packing with a nasal balloon or merocel may be necessary if bleeding persists Posterior epistaxis can be...

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Podcast 535: A Prescription for Falls show art Podcast 535: A Prescription for Falls

Emergency Medical Minute

Contributor:  Aaron Lessen, MD Educational Pearls:   Emergency department evaluation of falls, particularly in the elderly, should include an assessment of risk factors Common causes of falls in the elderly include medications. Review medication list for sedating medications amongst others Consult with your hospital physical therapist to discuss fall prevention techniques with the patient  One study has shown that a comprehensive interdisciplinary approach to geriatric falls in the ED can reduce return visits and hospital admissions.    References Caplan GA,...

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Mental Health Monthly #1: Decision Making Capacity show art Mental Health Monthly #1: Decision Making Capacity

Emergency Medical Minute

In the first episode of this new series, the complexities of decision making capacity are discussed.  References and Further Reading: Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840.   Etchells, E., Darzins, P., Silberfeld, M., Singer, P. A., McKenny, J., Naglie, G., ... & Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of general internal medicine, 14(1), 27-34.    

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Podcast 534: Nerve Agents show art Podcast 534: Nerve Agents

Emergency Medical Minute

Author: Michael Hunt, MD Educational Pearls: Organophosphate “nerve agents” were developed in the 1930’s These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE” Salivation Lacrimation Urination Defecation  GI cramping Emesis  The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis  Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis  Treatment...

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More Episodes

Contributor: Don Stader, MD

Educational Pearls:

  • Only 10% of patients receiving antibiotics for strep throat actually have the diesease
  • Treatment of strep with antibiotics only slightly reduces the duration of illness. Most studies say the reduction is between 16 and 24 hours
  • Antibiotic treatment may reduce complications such as peritonsilar abscess and otitis media but antibiotics also increase the risk of diarrhea and yeast infection
  • Rheumatic fever is caused by a specific serotype of strep that is no longer prevalent in the United States, so treating strep throat likely has no effect on preventing this complication 

References

Anand Swaminathan, "Do Patients with Strep Throat Need to Be Treated with Antibiotics?", REBEL EM blog, January 5, 2015. Available at: https://rebelem.com/patients-strep-throat-need-treated-antibiotics/. 

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD