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Podcast 519: Malaria Drug Resistance 

Emergency Medical Minute

Release Date: 11/19/2019

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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Podcast 533:  Hypoglycemia show art Podcast 533:  Hypoglycemia

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: Insulin related hypoglycemia can vary from a brief transient effect from short-acting forms (i.e. insulin lispro) to prolonged from long acting (i.e. insulin glargine), and will require different treatment and/or observation Of oral glycemic agents, sulfonylureas are a common culprit while metformin is rarely a cause Sulfonylureas also deserve attention because in pediatric patients, they can be lethal even with a single ingestion, but also can cause severe hypoglycemia in adults Hypoglycemia in non-diabetics usually occurs in the...

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Podcast 532:  SVC Syndrome show art Podcast 532:  SVC Syndrome

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing, and parasthesias Common causes of SVC syndrome include lung cancer, lymphoma, and thymoma Keep SVC syndrome on the differential for all patients with facial or upper extremity swelling References The superior vena cava syndrome: clinical characteristics and evolving etiology. Rice TW, Rodriguez RM, Light RW. Medicine (Baltimore). 2006;85(1):37.  Diagnosis and management of superior vena...

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Podcast 531:  Migraine Cocktail  show art Podcast 531:  Migraine Cocktail 

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.  The most effective agent in the cocktail is a dopaminergic agent  Routine IV fluids have not shown efficacy  There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl) Decadron reduces rebound headache  Consider trigger point injections for those with migraine attributable to cervical neck pain.  References Jones CW, Remboski LB, Freeze B, Braz VA, Gaughan JP, McLean...

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Podcast 530: Anion Gap Acidosis + Metformin Toxicity show art Podcast 530: Anion Gap Acidosis + Metformin Toxicity

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: The common causes of anion gap metabolic acidosis include (MUDPILES) Metformin, Methanol  Uremia  DKA Paraldehyde  INH/Iron  Lactate Ethylene Glycol  Salicylate  Metformin is a very common drug used to treat type 2 diabetes, however in the right setting, it can cause a profound lactic acidosis. There is a very high mortality rate.  Treatment of metformin toxicity includes fluids, bicarb, and dialysis  Most commonly, metformin toxicity is in the setting of kidney injury or overdose.  Always...

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Podcast 529: Hemophilia show art Podcast 529: Hemophilia

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Hemophilia is characterized by bleeding (A /B) A is is 8, B (chrstmas, 9)  Hemophilia refers to a group of bleeding disorders caused by a deficiency in a certain clotting factor. The two most common are hemophilia A (caused by a lack of factor VIII), and B (caused by a lack of factor 9) Most cases are inherited in an X-linked recessive manner. Therefore, males are the most commonly affected. However, spontaneous cases do occur in all sexes. People with hemophilia can present to the ED with a variety of bleeding complications including...

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Podcast 528:  Decompensated Liver Failure  show art Podcast 528:  Decompensated Liver Failure 

Emergency Medical Minute

Contributor: Michael Hunt, MD Educational Pearls: Cirrhosis is the end stage of chronic structural damage to the liver. This is most commonly due to  alcohol but other causes viral hepatitis and hepatotoxic drugs Cirrhotic patients are very prone to GI bleeding and infections, partially due to the role the liver plays in producing immune and clotting factors These patients can easily become “sick”. Use the shock index (heart rate / systolic blood pressure) as a rapid assessment of hemodynamic status. >0.7 is worrisome, >1 should prompt resuscitation.  Because cirrhotic...

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Podcast 527: Knee Dislocations show art Podcast 527: Knee Dislocations

Emergency Medical Minute

Contributor:  Erik Verzemnieks, MD Educational Pearls: Knee dislocations are most common in high energy trauma, such as a motor vehicle accident The knee may appear grossly normal on initial inspection since dislocations can spontaneously reduce - Look for such findings as hemarthrosis, instability, or ecchymosis, as clues to an occult dislocation.  Knee dislocations are often associated with damage to the popliteal artery that runs behind the knee.  Assess for pulse deficit on exam. If you are concerned - use the ankle-brachial index (normal >0.9). If the ABI is abnormal,...

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Podcast 526:  Desmopressin for Intracranial Hemorrhage  show art Podcast 526:  Desmopressin for Intracranial Hemorrhage 

Emergency Medical Minute

Contributor: Charleen Melton, PharmD Educational Pearls: Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works by increasing the release of Von Willebrand factor, helping to stabilize clots.  The use of DDAVP for intracranial hemorrhage in patients on antiplatelet agents (mainly Aspirin and Plavix) was recently reviewed In this retrospective review, they found an 88% decreased likelihood of hemorrhage expansion, in those who received DDAVP, compared to those who did not. Furthermore, they found no...

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Podcast 525:  Enjoyable Epistaxis? show art Podcast 525:  Enjoyable Epistaxis?

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: The ED is full of painful procedures. One of the most commonly dreaded procedures is nasal packing for epistaxis, as it is quite uncomfortable for the patient.  A recent study compared TXA with compression, saline with compression, and traditional nasal packing for the treatment of epistaxis.  Hemostasis was achieved in 91% with TXA and compression, 93% with nasal packing, and 71% with saline and compression. There was no statistically significant difference between the packing and TXA groups. Furthermore, there was no difference in...

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Contributor: John Winkler

Educational Pearls:

  • There is increasing resistance to antimalarial drugs, especially in P. falciparum. This trend started with chloroquine, but is now spreading to the other first-line drugs. 
  • Resistant strains have been identified in Cambodia and Thailand
  • 220 million people were infected last year
  • The best treatment of malaria is prevention from bites - DEET and permethrin are typical effective options.
  • Permethrin may be applied to clothing items before travel, and will last through 6-8 wash cycles.
  • While malaria is rare in the US, it should be considered in those having recently travelled

References

Hamilton WL, Amato R, van der Pluijm RW, et al. Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study. Lancet Infect Dis. 2019;19(9):943–951. doi:10.1016/S1473-3099(19)30392-5

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