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Podcast 528:  Decompensated Liver Failure 

Emergency Medical Minute

Release Date: 01/06/2020

Podcast 543: Scoring Blunt Traumatic Aortic Injury show art Podcast 543: Scoring Blunt Traumatic Aortic Injury

Emergency Medical Minute

Author: Nick Tsipis, MD Educational Pearls: Aortic injury caused by blunt trauma is very rare Chest x-ray findings might include widening of the mediastinum Ligamentum arteriosum (remnant of the ductus arteriosus) tethers the aorta to the chest wall, potentially causing injury with abrupt decelerations and motion XR lacks significant sensitivity (around 75%) to be utilized in many cases CT angiogram (CTA) of the chest is typically the preferred test but comes with potential risks including radiation exposure is a scoring tool that may provide value in determining the need for additional...

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Mental Health Monthly #2: Non-Epileptic Seizures (NES) show art Mental Health Monthly #2: Non-Epileptic Seizures (NES)

Emergency Medical Minute

Non Epileptic Seizures (NES) is perhaps one of the most misunderstood and overlooked disorders that emergency medicine professionals encounter. Dr. Randi Libbon & Dr. Laura Strom, both experts on NES, explain the ongoing research surrounding the topic as well as how to best manage patients with NES in the emergency setting.  To learn more about Dr. Randi Libbon: To learn more about Dr. Laura Strom:   References & Further Reading: Baslet G, Seshadri A, Bermeo-Ovalle A, Willment K, Myers L. Psychogenic Non-epileptic Seizures: An Updated Primer. Psychosomatics....

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Podcast 542: Nasogastric Tubes show art Podcast 542: Nasogastric Tubes

Emergency Medical Minute

Author: Don Stader, MD Educational Pearls: Nasogastric tubes (NGT) are very uncomfortable for all those involved but some simple tricks and tips may help: Topical lidocaine can be inserted into the nasal passage for local analgesia Afrin may help shrink the mucosal tissue of the nasal turbinates as well Molding the tube with cold/ice water can help - putting it in an ice bath with an endotracheal tube stylet will allow you to mold the tip to your preference References Lor YC, Shih PC, Chen HH, et al. The application of lidocaine to alleviate the discomfort of nasogastric tube insertion: A...

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Podcast 541: Needle Thoracostomy show art Podcast 541: Needle Thoracostomy

Emergency Medical Minute

Author: Aaron Lessen, MD Educational Pearls: Traditional technique of needle thoracostomy for tension penumothorax is along the 2nd intercostal space at the midclavicular line Inserting a large angiocatheter along the 4th or 5th intercostal space at the mid-axillary line may provide a thinner area that is more easily identified, overcoming many of the obstacles of the traditional approach The 10th Edition of ATLS now recommends this location as well A finger thoracostomy, where a scalpel and then the finger are used to penetrate the pleural cavity at the same location, is another method to...

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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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More Episodes

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 patients are immunocompromised, do not rely on the presence of fever and peritonitis to diagnose spontaneous bacterial peritonitis (SBP), and have a low threshold to perform a diagnostic paracentesis
  • Polymorphonuclear (PMN) count > 250 in the ascitic fluid suggests SBP
  • With GI bleeding in cirrhotics, antibiotics have a mortality benefit, while PPIs and octreotide have limited benefit

References

Chinnock B, Hendey GW, Minnigan H, Butler J, Afarian H. Clinical impression and ascites appearance do not rule out bacterial peritonitis. J Emerg Med. 2013 May;44(5):903-9. doi: 10.1016/j.jemermed.2012.07.086. Epub 2013 Mar 7.

Pericleous M, Sarnowski A, Moore A, Fijten R, Zaman M. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. Eur J Gastroenterol Hepatol. 2016 Mar;28(3):e10-8. doi: 10.1097/MEG.0000000000000548.

Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M.Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther. 2011 Sep;34(5):509-18. doi: 10.1111/j.1365-2036.2011.04746.x. Epub 2011 Jun 27.

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