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Podcast 509: Circadian Rhythm and Shift Work, From Z to Z

Emergency Medical Minute

Release Date: 10/12/2019

Podcast 585:  You Sure You Want Colchicine for Gout? show art Podcast 585:  You Sure You Want Colchicine for Gout?

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Gout is an arthritis caused by the deposition of urate crystals into the joint space Colchicine works by disrupting microtubules and prevents white blood cells from getting into the joint space which stops the inflammatory response  Colchicine has a high rate of adverse events, in particular explosive diarrhea The drug also has a very narrow therapeutic index and overdose is nearly universally fatal, with no antidote or effective treatment option available Alternative agents such as steroids, which reduce the inflammatory response to urate...

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Podcast 584:  Ketamine for Depression and Suicidality  show art Podcast 584:  Ketamine for Depression and Suicidality 

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Suicide is currently the 10th leading cause of death in the US  Low quality studies have reported ketamine as a potential promising agent in treating depression and preventing suicidal ideations or thoughts Randomized study was performed looking at giving ketamine to depressed patients in the ED to see if they could establish a proof of concept, meaning: would looking at ketamine for treatment of acute depression or suicidality be viable? 18 suicidal patients who required hospitalization for their depression and suicidality were entered in...

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Podcast 583:  Raise Your Hands if You Have Carpal Tunnel Syndrome    show art Podcast 583:  Raise Your Hands if You Have Carpal Tunnel Syndrome   

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Hand raising test: a simple but effective tool to diagnose carpal tunnel  Patients hold their hands over their head and if symptoms of carpal tunnel develop within 2 minutes, it is considered positive, meaning they likely have carpel tunnel Symptom included numbness and dull pain in the distribution of the median nerve Treatment for carpal tunnel in the ED can include splinting in a neutral position and oral steroids with possible follow up for steroid injections or surgery References Padua L, Coraci D, Erra C, et al. Lancet Neurol....

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Rapid Fire Pharmacy Review with Adis Keric of ER-Rx show art Rapid Fire Pharmacy Review with Adis Keric of ER-Rx

Emergency Medical Minute

Meet Adis Keric, Board Certified Pharmacotherapy Specialist and a Board Certified Critical Care pharmacist who works in the Emergency Department and ICU of level 1 trauma center Regions Hospital in Saint Paul, MN. Adis is the founder and host of a new FOAMed podcast, ER-Rx. He started the podcast to inform clinicians in the ED and ICU about up-to-date, appropriate and optimal use of medications in different clinical scenarios. Dr. Nick Tsipis sits down with Adis to discuss some pearls in Emergency Medicine Pharmacy.  Time Stamps: 0:10 Intros 4:35 Antibiotics 8:30 Post-Intubation Sedation...

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Podcast 582:  Gadolinium - The Contrast of MRI show art Podcast 582: Gadolinium - The Contrast of MRI

Emergency Medical Minute

Contributor: Michael Hunt, MD Educational Pearls: Contrast agents are commonly used for X-rays and CT’s to better characterize disease, but contrast doesn’t work with MRI. That’s where the element Gadolinium comes into play. Gadolinium, element 64, is ferromagnetic (attracted to iron) below 68 degrees and above that temperature it’s paramagnetic which makes it useful in MRI (Magnetic Resonance Imaging). Gadolinium is toxic alone, but when paired with chelators it can be used in humans and allows for better characterization of tumors or abnormal tissue on MRI. It helps identify this...

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Podcast 581:  Alcohol Complications show art Podcast 581:  Alcohol Complications

Emergency Medical Minute

\Contributor: Don Stader, MD Educational Pearls: Altered mental status/confusion are major symptoms associated with both alcohol use and withdrawal. Wernicke’s encephalopathy is a triad of symptoms of confusion, internuclear ophthalmoplegia, and confabulation The treatment for Wernicke’s is IV thiamine or vitamin B1 Untreated Wernicke’s leads to Korsakoff's syndrome where a prolonged thiamine deficiency leads to worsening brain function  Subdural hematomas from torn bridging veins are common in alcoholics because of the combination of frequent falls and cerebral atrophy caused by...

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On The Streets #6: Artificial Intelligence Detection for LVOs show art On The Streets #6: Artificial Intelligence Detection for LVOs

Emergency Medical Minute

Meet Michelle Whaley, Clinical Nurse Specialist and Stroke Program Coordinator at Sky Ridge Medical Center in Lone Tree, Colorado. Jordan and Michelle discuss advances in Artificial Intelligence technology in an app that uses algorithms to analyze CT Angiograms to alert physicians of patients with images concerning for Large Vessel Occlusions (LVOs). Listen as they discuss the sweeping implications of this technology in the realm of stroke care and how it is decreasing wait times for critical patients to receive tPA and interventional procedures.   For EMS, this technology is already...

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Podcast 580:  Origin of PPE   show art Podcast 580:  Origin of PPE  

Emergency Medical Minute

Contributor: Michael Hunt, MD Educational Pearls: PPE, or personal protective equipment, has become a major talking point since the emergence of the novel coronavirus (COVID 19). While ubiquitous now, there was not always equipment to protect health care providers or patients from infectious exposures. The invention of  surgical gloves are credited to surgeon William Halsted. He developed gloves because one of his assistants (and later wife), Carol Hampton, was having severe irritation due to a caustic pre-op disinfecting process. They developed the rubber glove for Hampton which...

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Podcast 579:  Yersinia Pestis show art Podcast 579:  Yersinia Pestis

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Yersinia Pestis is the bacteria that caused the black plague. It was first discovered to be the cause of the bubonic plague in 1800s in China during the 3rd bubonic plague where 10-20 million people died Causes 3 types of plague: Bubonic plague: characterized by severe swelling of lymph nodes called buboes, most commonly in the groin, also axillary and olecranon lymph nodes. Septicemic plague: characterized by severe sepsis, no lymphadenopathy. This strain famously causes disseminated intravascular coagulopathy (DIC) and can lead to limb...

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Podcast 578: Brown-Sequard Syndrome  show art Podcast 578: Brown-Sequard Syndrome 

Emergency Medical Minute

Author: Eric Miller, MD Educational Pearls: Brown-Sequard Syndrome is a neurological deficit that results from hemisection of the spinal cord  This is usually from traumatic injury (blunt or penetrating), but can rarely be seen with cancer, disc herniation, or infection It presents with flaccid paralysis and loss of sensation to touch/vibration/position on the same side as the injury with loss of pain/temperature sensation on the opposite side of the injury.  These deficits will be below the level of injury.    References Roth, E., Park, T., Pang, T. et al. Traumatic...

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More Episodes

Contributor: Jared Scott, MD

Educational Pearls:

  • Sleep deprivation and disturbed sleep cycles increases the risk of many acute and chronic medical issues such as motor vehicle accidents, diabetes, cardiovascular disease, psychiatric disease,  and shift work sleep disorder (difficulty sleeping, fatigue, interference with daily activities)
  • Stages of sleep 
    • Stage 1: 5-10 minutes (light sleep, may not recognize). 
    • Stage 2: Spindle waves, mostly unstudied 
    • Stage 3: Restorative sleep
    • Stage 4 (REM): Paralysis, memory consolidation
  • One sleep cycle takes about 120 minutes
  • Light is critical for regulating sleep cycles. Exposure to light (especially blue light) inhibits melatonin release from the pineal gland, which influences the suprachiasmatic nucleus (master sleep controller in the brain)
  • How can you optimize sleep before your night shifts? On the day of your first night shift, sleep until you wake naturally, then take a 90min nap between 2-6pm before you start your shift 
  • Sleepy on shift? A 5 minute nap is helpful to increase your attention span and thinking. A 30 minute nap is good for achieving more restorative sleep. Naps between 30 and 60 minutes are not recommended due to increased sleep inertia 
  • How do I optimize myself on shift? Keep active and take a 5 minute nap if needed. Do not use caffeine within the last 4 hours of your shift (it will interfere with your sleep!). More than 200-300mg a caffeine are not recommended, if you do use it.Use built in checks to reduce errors, as errors are increased during night shifts! 
  • Leaving your shift, reduce exposure to light by wearing sunglasses, avoid screens and alcohol, and get to sleep ASAP
  • Got things to do? Remember that some sleep is better than none! 

References

Kuhn G et al. Circadian rhythm, shift work, and emergency medicine. Ann Emerg Med. (2001) 37:1, 88-98.

McKenna Helen, Wilkes Matt. Optimising sleep for night shifts BMJ (2018). 360:j5637

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

Music credit: “Smooth Lovin” by Kevin MacLoed (incompetech.com). Licensed under Creative Commons By Attribution 3.0 License. http://creativecommons.org/licenses/by/3.0/