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CBHW Summit: The Cycle of Drug-Related Stigma - Implications for the Opioid Crisis

Emergency Medical Minute

Release Date: 11/27/2019

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: [1] Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840.   [2] 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.   Joint Centre for Bioethics - Aid to Capacity Evaluation (ACE)...

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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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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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From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributor: 

Michael Miller, Strategic Initiatives Coordinator, Jefferson County Public Health