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Podcast 514: Pain Control While on Naltrexone 

Emergency Medical Minute

Release Date: 10/30/2019

Podcast 618: Treating Opiate Side Effects show art Podcast 618: Treating Opiate Side Effects

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Majority of patients experience side effects while taking opioids Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol) Itching from opiates isn’t histamine mediated so hydroxyzine (Atarax) and diphenhydramine (Benadryl) aren’t effective - oddly...

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Podcast 617: Masks and Understanding Data show art Podcast 617: Masks and Understanding Data

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Recent study looked at if mask wearing protects the mask wearer from infection This group found 1.8% of mask wearers got COVID while 2.1% of non-mask wearers became infected, which was not statistically significant This was not statistically significant and has been used to justify not wearing masks by some groups While the numbers look small, it's close to a 20% reduction in infections for the mask wearers The results reported had concerns for being underpowered, meaning the studies population may not be big enough to draw definitive...

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Pharmacy Phriday #4: mRNA Vaccines show art Pharmacy Phriday #4: mRNA Vaccines

Emergency Medical Minute

Contributor: Rachael Duncan, PharmD Educational Pearls:  ED visits nationwide declined by 42% in April 2020 compared to the same time in 2019 largely due to the fear of the COVID-19 pandemic. The biggest decline was seen in pediatrics less than 14, women and emerging COVID hotspots like the Northeast. In recent weeks, this trend has reversed, showing a record-breaking number of COVID cases, hospitalizations, and deaths. As hospitals reach capacity, critically ill COVID patients are being held in the ED until an inpatient bed becomes available.  A new mRNA vaccine has promising...

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Mental Health Monthly #5: Borderline Personality Disorder show art Mental Health Monthly #5: Borderline Personality Disorder

Emergency Medical Minute

For this episode of Mental Health Monthly, EMM is honored to collaborate with the hosts of Millennial Mental Health Channel podcast to explain Borderline Personality Disorder and tips to manage patients with this diagnosis in the Emergency Department. Dr. Justin Romano is a third year psychiatry resident in Omaha, Nebraska and Eddie Carrillo is a licensed mental health therapist currently working at partial hospitalization and IOP eating disorder program in Portland, Oregon. Their podcast Millennial Mental Health Channel seeks to explore the world of mental health from their two professional...

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Podcast 616: MDIs for the Win show art Podcast 616: MDIs for the Win

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Contrary to many assumptions, meter-dose inhalers (MDIs) are as effective as nebulizers in pediatric and adult patients Nebulizers are associated with higher rates of tremor, tachycardia; they cost more and are associated with longer ED stays Though it may take some convincing, in a patient that is physically able, using an MDI with spacer appears to be the better option - and that was even before COVID. References Snider MA, Wan JY, Jacobs J, Kink R, Gilmore B, Arnold SR. . J Emerg Med. 2018 Jul;55(1):7-14. doi:...

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Podcast 615: Pediatric DKA show art Podcast 615: Pediatric DKA

Emergency Medical Minute

Contributor: Ryan Circh, MD Educational Pearls: Diabetic ketoacidosis (DKA) can be the initial presenting condition of undiagnosed diabetes type I in pediatric patients Unlike adults, children typically need less fluid (i.e. 10 mL/kg bolus for those in shock followed by maintenance) Cerebral edema is a concern from rapid administration of fluids An insulin drip at 0.1 units/Kg/hr should be started but a bolus isn’t required Editor’s note: While conceptually similar, treatment for pediatric DKA is overall less aggressive (no bolus of insulin, less fluids, slower corrections, etc.). also...

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Podcast 614: Perichondritis show art Podcast 614: Perichondritis

Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Perichondritis involves infection of not only the connective tissue of the ear but typically the cartilage as well Symptoms include erythema, ear pain, and fevers The most common bacterial cause is Pseudomonas. Perichondritis often occurs after a wound or piercing, but trauma is not necessary for the infection to occur Anti-pseudomonal coverage is essential with typically oral agents for milder disease and IV antibiotics for severe infections Can have devastating outcomes if not treated aggressively and/or treated early due to poor blood supply...

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Podcast 613: Spontaneous Bacterial Peritonitis show art Podcast 613: Spontaneous Bacterial Peritonitis

Emergency Medical Minute

  Contributor: Sam Killian, MD Educational Pearls: Spontaneous bacterial peritonitis (SBP) is an infection of peritoneal fluid that typically occurs in cirrhotic patients Symptoms may include abdominal pain, fever, and/or altered mental status Paracentesis is diagnostic test of choice. Diagnostic criteria includes > 250 polymorphonuclear cells (PMNs) or a positive gram stain/culture Treatment is typically a 3rd generation cephalosporin ·30-40% of SBP patients will go into renal failure and SBP associated with sepsis has an ~80% mortality References Dever JB, Sheikh MY. . Aliment...

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Pharmacy Phriday #3: Drug Shortages in COVID show art Pharmacy Phriday #3: Drug Shortages in COVID

Emergency Medical Minute

Contributor: Rachael Waterson, PharmD Educational Pearls:  Drug shortages have been an ongoing issue since the 2000’s. Improvement was being made; however, several factors have exacerbated the drug supply more recently. According to the US Food and Drug Administration (FDA) Report there are 163 drugs currently on the drug shortage list. Of the 40 drugs critical to treating COVID-19, 18 are on this list.  In comparison, according to the American Society of Health-Systems Pharmacists (ASHP), the current drug shortages have limited 29 of the 40 drugs deemed critical to treating...

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UnfilterED #11: Dr. Ricky Dhaliwal show art UnfilterED #11: Dr. Ricky Dhaliwal

Emergency Medical Minute

Dr. Tsipis sits down with colleague Dr. Ricky Dhaliwal for some insightful conversation regarding the differences between academic and community settings as well as the various roles of advocacy in medicine.  Time Stamps 00:23 Banter and introductions 2:41 upbringing in 1st generation immigrant Indian household 14:30 losing culture as 2nd gen immigrant 7:32 Balancing family and work with a two doc family 8:32 President of EMRA 10:42 Working in academia vs community 13:29 New job advice 15:55 Nick talks about being the product of your environment and needing to be challenged 20:42 Advocacy...

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Author: Don Stader, MD

Educational Pearls:

  • Suboxone, methadone, and naltrexone are commonly used as treatments for opiate use disorder. 
  • Naltrexone is a full mu-opiate receptor antagonist, making acute pain control difficult in patients taking it. 
  • Options for pain control in patients on naltrexone include nerve blocks, NSAIDS, ketamine, and high doses of opiates. 
  • Of the opiates, Dilaudid (hydromorphone) has the highest affinity for mu-opiate receptors, and will be the most effective.

References

Vickers AP, Jolly A. Naltrexone and problems in pain management. BMJ. 2006;332(7534):132–133. doi:10.1136/bmj.332.7534.132

 

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