loader from loading.io

Podcast 536:  Epistaxis 101

Emergency Medical Minute

Release Date: 01/28/2020

Podcast 553: Airway Management in the Hypoxic COVID-19 Patient (Recorded 4/3/20) show art Podcast 553: Airway Management in the Hypoxic COVID-19 Patient (Recorded 4/3/20)

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational pearls: Clinical management of COVID-19 is rapidly evolving, relying on case reports and clinical experience In just a month, the consensus around management of COVID patients with severe hypoxia has shifted from an early intubation strategy to other, non-invasive means Intubating early can quickly consume ventilator resources, require increased intensive care monitoring, and likely leads to longer hospital stays and once COVID patients are intubated, extubation can take days to weeks. In Italy, ventilator supplies were depleted leading to the use of...

info_outline
COVID-19 Digest: Hydroxychloroquine Update (Recorded 4/3/20) show art COVID-19 Digest: Hydroxychloroquine Update (Recorded 4/3/20)

Emergency Medical Minute

In our coverage of COVID-19 this week, we’ve investigated the shakey evidence for NSAID use making COVID worse, heard first-hand accounts from ED clinicians with COVID, and looked at the status of testing in the United States. Before capping our week of coverage off, we wanted to analyze some of the most recent literature on clinical interventions for COVID, particularly the recently FDA approved hydroxychloroquine.  Host: Elizabeth Esty, MD Research By: Elizabeth Esty and Nathan Novotny Sound Editing By: Stephen Bahmani References Wang M, Cao R, Zhang L, et al. Remdesivir and...

info_outline
COVID-19 in the United States: Where are the tests? show art COVID-19 in the United States: Where are the tests?

Emergency Medical Minute

A dive into how the United States responded to an emerging pandemic and the pitfalls along the way that led to stalled testing capacity across the country before community transmission was confirmed. Hear what led us to our current situation, what continues to be an issue and new technologies on the horizon as well as how the rest of the world has responded. Host: Elizabeth Esty, MD Research By: Mason Tuttle Sound Editing By: Stephen Bahmani   References: Shear M, Goodnough A, Kaplan S, Fink S, Thomas K, Weiland N. The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19. The...

info_outline
Husband & Wife, Both ER Clinicians, Share Their Experience Having COVID-19 show art Husband & Wife, Both ER Clinicians, Share Their Experience Having COVID-19

Emergency Medical Minute

Long time friends of EMM, Aaron and Bree, share their experiences on the frontlines in the ED, coping with COVID, managing anxiety and quarantining with their family.

info_outline
COVID-19 Digest: Do NSAIDs Make COVID-19 More Severe? (Recorded 3/30/20, 18:00 MST) show art COVID-19 Digest: Do NSAIDs Make COVID-19 More Severe? (Recorded 3/30/20, 18:00 MST)

Emergency Medical Minute

In the past two weeks, warnings, questions, and misinformation concerning COVID-19 and NSAID use have been spreading...no pun intended..virally. The pace of this evolving pandemic and the equally quick pace of the news and social media news cycle have meant that information and misinformation travel equally fast. Today we bring to you the story of how a letter in The Lancet led to a world of confusion. Host: Elizabeth Esty, MD Research By: Elizabeth Esty & Nathan Novotny Sound Editing By: Stephen Bahmani Time Stamps: 0:00 - COVID-19 Statistics 2:55 - The Lancet Letter: What Started the...

info_outline
Podcast 552: PE Management and Risk Stratification show art Podcast 552: PE Management and Risk Stratification

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: After you diagnose a pulmonary embolism (PE) via CT or VQ scan, we need to categorize the PE as massive, sub-massive, or just PE to dictate treatment.   Massive PE: shock with hypotension due to an embolism, and the treatment of choice is thrombolysis with IV tPA with anticoagulation after lysis. Catheter thrombolysis is not used in the hemodynamically unstable patient but can be done after they are stable. Sub-massive: signs of right heart strain/failure but hemodynamically stable. This can be EKG changes, positive biomarkers, or...

info_outline
COVID-19 Digest: If You’ve Had COVID-19, Can You Get it Again? / Convalescent Serum (Recorded 3/26/20, 18:00 MST) show art COVID-19 Digest: If You’ve Had COVID-19, Can You Get it Again? / Convalescent Serum (Recorded 3/26/20, 18:00 MST)

Emergency Medical Minute

Host: Elizabeth Esty, MD Research By: Elizabeth Esty and Nathan Novotny References: Osumi M. Questions raised over COVID-19 reinfection after Japanese woman develops illness again. The Japan Times. https://www.japantimes.co.jp/news/2020/02/28/national/coronavirus-reinfection/#.Xn4coZNKhQI. Published February 28, 2020. Bao L, Deng W, Gao H, et al. Reinfection could not occur in SARS-CoV-2 infected rhesus macaques. bioRxiv. March 2020:2020.03.13.990226. doi:10.1101/2020.03.13.990226 Steinbuch Y. Doctor asks recovered coronavirus patients to be tested for antibodies. New York Post....

info_outline
ER Doc Infected with COVID-19 Shares Experience show art ER Doc Infected with COVID-19 Shares Experience

Emergency Medical Minute

Recorded 3/26/20

info_outline
COVID-19: Hydroxychloroquine & Azithromycin / Anosmia / The Aerosolized vs. Droplet Debate (Recorded 3/24/20, 18:00 MST) show art COVID-19: Hydroxychloroquine & Azithromycin / Anosmia / The Aerosolized vs. Droplet Debate (Recorded 3/24/20, 18:00 MST)

Emergency Medical Minute

The circumstances surrounding the COVID-19 virus are quickly evolving and that means that EMM will have to as well. For the foreseeable future, EMM will be releasing COVID-19 updates. In this series, we will report the most recent statistics, summarize the newest literature and answer YOUR burning questions. Submit your questions through comments on this post or through private messages on any of our social media platforms. Host: Elizabeth Esty, MD Research By: Elizabeth Esty, Jackson Roos, Nathan Novotny & Mason Tuttle Time Stamps: 0:00 - COVID-19 by the numbers 2:50 - Hydroxychloroquine...

info_outline
Podcast 551:  PPIs are Not Benign show art Podcast 551:  PPIs are Not Benign

Emergency Medical Minute

  Contributor: Don Stader, MD Educational Pearls: PPIs (Proton pump inhibitors) reduce stomach acid levels and are commonly prescribed in patients with GERD or peptic ulcer disease Stopping a PPI after sustained use for a month or longer can lead to withdrawal - causing a rebound indigestion or reflux due to a surge in acid production Long term PPI use has noteworthy side effects including increased incidence of bacterial GI infections and pneumonia Be cautious in prescribing a PPI for over 2 weeks. If continued indigestion control is needed, transition to a H2 blocker or OTC antacids if...

info_outline
 
More Episodes

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 potentially devastating - for all practical purposes are epistaxis that does not resolve with anterior packing
  • Interventional radiology can be a helpful consultant for controlling of posterior epistaxis, and may be just as or more helpful than ENT

 

References

Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(7):744-749.

Shargorodsky J, Bleier B, Holbrook E, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-398.

Singer A, Blanda M, Cronin K, et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med. 2005;45(2):134-139.

Womack JP, Kropa J Jimenez Stabile M. Epistaxis: Outpatient Management. Am Fam Physician. 2018 Aug 15;98(4):240-245.

Liu WH, Chen YH, Hsieh CT, Lin EY, Chung TT, Ju DT. Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature. Am J Emerg Med. 2008 May;26(4):516.e3-5. doi: 10.1016/j.ajem.2007.07.036.

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