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Podcast 531:  Migraine Cocktail 

Emergency Medical Minute

Release Date: 01/13/2020

UnfilterED #10: Debi Smith show art UnfilterED #10: Debi Smith

Emergency Medical Minute

General Counsel attorney, Debi Smith, joins Dr. Nick Tsipis to discuss the ins and outs of healthcare law. Many people forget that a subpoena only compels attendance to a court date, it does not compel one to provide any information on a case without a specific HIPAA compliant authorization for use and disclosure of protected health information. Tune in for more details, perspective on the intricacies of the legal world as it pertains to medicine and for tips on how to navigate different general situations from contracts to litigation.    Time Stamps 0:47 Legal Disclaimer 3:14...

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Podcast 598: Sepsis, Round One show art Podcast 598: Sepsis, Round One

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Early antibiotics have been shown to improve outcomes in septic patients time after time Emerging evidence challenges the concept of one-size-fits-all large fluid boluses for septic shock patients and fluid may worsen patients who have underlying sepsis-induced pulmonary capillary leak Starting peripheral vasopressors early, and relaxing if fluid resuscitation is successful, is appearing to be a more appropriate strategy than fluids first, then vasopressors References CLASSIC Trial Group; Scandinavian Critical Care Trials Group. Intensive...

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Podcast 597: Weather Can be a Headache show art Podcast 597: Weather Can be a Headache

Emergency Medical Minute

  Contributor: Sam Killian, MD Educational Pearls: One study found that patients presented with headaches more frequently when there was high temperatures and low humidity, while higher humidity is correlated to lower incidence of headache. Moon phases had no effect on headache frequency. A Canadian study looking at over 100,000 ED visits for headaches found increased incidence of headaches when there were higher levels of air pollution/particulates, like smoke. References Yilmaz M, Gurger M, Atescelik M, Yildiz M, Gurbuz S. Am J Emerg Med. 2015;33(3):409-413....

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Pediatric Emergencies Brewcast: Pediatric Trauma show art Pediatric Emergencies Brewcast: Pediatric Trauma

Emergency Medical Minute

Emergency Medical Minute collaborated with CarePoint Health in early March for a night of education on Pediatric Emergencies at a local Denver brewery for our latest Brewcast. Pediatric patients require special considerations compared to adults when receiving medical care, and that remains true for traumatic injuries dealt with in the ED and pre-hospital settings. Dr. Christine Darr, Pediatric Emergency Medicine Physician, discusses a range of traumatic injuries in pediatric patients and how to appropriately perform a physical exam, order radiographic diagnostics to further assess and identify...

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Podcast 596: Peripheral Vasopressors show art Podcast 596: Peripheral Vasopressors

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Traditional teaching has shied away from using vasopressors through peripheral IVs Tissue necrosis from extravasation is cited as a risk of use of vasopressors through a peripheral site However, risk of extravasation is low (2-4%) and even more rarely results in significant complications Using an  IV that is more proximal and larger bore with monitoring can further minimize these risks Starting with peripheral vasopressors in a critically ill patient appears to be without significant increased cutaneous complications compared to using a...

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Podcast 595: Smoking. Still Bad show art Podcast 595: Smoking. Still Bad

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: On average, smoking reduces life expectancy by 13.2 years for men and for 14.5 years for women Nicotine is highly addictive and has both stimulant and calming effects Having a newborn can be a strong motivator to quit so take advantage and educate new (or expecting) parents to the risks of smoking and benefits of quitting Smoking has been associated with sudden infant death Biggest predictor of children smoking is seeing their parents smoking Side effects of smoking that can be discussed with patients are cataracts/blindness, cancers (lung and...

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On The Streets #8: Limb Injury and Preservation show art On The Streets #8: Limb Injury and Preservation

Emergency Medical Minute

Dr. Glenda Quan, esteemed Trauma Surgeon at Swedish Medical Center, discusses cases related to limb injury and reviews their management.  Topics include proper tourniquet application as well as alternatives to commercially available devices how to manage pain or a difficult patient with significant limb injury. We also explore the use of new “hybrid ORs” where multiple surgical teams can care for various injuries simultaneously and briefly chat about the use of blood products in the prehospital setting.  Thought we were done? Nope. We finish with pearls on temperature management...

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Podcast 594: Topicalization for Awake Intubations show art Podcast 594: Topicalization for Awake Intubations

Emergency Medical Minute

Contributor: Ricky Dhaliwal, MD, JD Educational Pearls: Topical anesthetization can allow for an awake intubation, which substantially decreases chance of loss of airway or respiratory drive because sedatives/paralytics are not necessary Lidocaine treatments like URO-JET (2% lidocaine jelly) can be applied through the nare followed by LMX cream (4% lidocaine) which should be applied to the back of the tongue to anesthetize the tongue and larynx. Good topicalization can be confirmed by testing for lack of a gag reflex References Simmons ST, Schleich AR. Reg Anesth Pain Med....

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Podcast 593: TXA for GIB show art Podcast 593: TXA for GIB

Emergency Medical Minute

Contributor: Ricky Dhaliwal, MD, JD Educational Pearls: Tranexamic acid (TXA) as shown to have mortality benefit to patients with traumatic GI hemorrhage but should it be used to achieve hemostasis in atraumatic GI bleeding? HALT-IT study looked at TXA for the treatment of upper and lower GI hemorrhage and found no 5 day mortality benefit Patients given TXA also had higher occurrences of DVT and PE References Roberts I, Coats T, Edwards P, et al. Trials. 2014;15:450. Published 2014 Nov 19. doi:10.1186/1745-6215-15-450   Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD ...

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Podcast 592:  Rapid Antihypertensives show art Podcast 592:  Rapid Antihypertensives

Emergency Medical Minute

Contributor: Ramnik Dhaliwal, MD, JD Educational Pearls: Nitrates Nitroprusside: becomes effective in under a minute, and becomes ineffective 10 minutes after stopping it.  Nitroprusside can metabolize into cyanide leading to toxicity, however this is rare. Nitroglycerin: predominately causes vasodilation but some arterial dilation as well; preferred agent in patients with volume overload/CHF Adrenergic Blocking Agents Labetalol: alpha/beta-blocking agent with a rapid onset of 5 minutes or less given as bolus or intravenous drip Esmolol: cardioselective beta blocker with rapid...

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More Episodes

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 SA..Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial.  Ann Emerg Med. 2019 Feb;73(2):150-156. doi: 10.1016/j.annemergmed.2018.09.004. Epub 2018 Oct 26.

Friedman BW, Cabral L, Adewunmi V, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016;67(1):32–39.e3. doi:10.1016/j.annemergmed.2015.07.495

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