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Podcast 570: Oh no no no to O2

Emergency Medical Minute

Release Date: 06/09/2020

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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Podcast 591: Pediatric Documentation Pearls show art Podcast 591: Pediatric Documentation Pearls

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 in the ED and pre-hospital settings. As such, it's important to be careful with the documentation of these patients to maintain accuracy and avoid inclusion of common normal findings that may populate in "normal patient" macros that are inappropriate for pediatric patients. Dr. Karen Woolf,...

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Pharmacy Phriday #2: Penicillin and Cephalosporin Allergies show art Pharmacy Phriday #2: Penicillin and Cephalosporin Allergies

Emergency Medical Minute

The penicillin and cephalosporin drug classes include many first line drug options for infectious disease although high rates of self-reported allergies may cause physicians to seek alternative options. In part two of our dive into antibiotics use for infectious disease, listen as Dr. Rachael Duncan, Emergency Medicine Clinical Pharmacist, addresses the need to investigate the validity of these reported allergies and their severity to avoid us elf riskier alternatives, like fluoroquinolones. Cross-reactivity between cephalosporins is most often dictated by side chain of cephalosporins rather...

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Mental Health Monthly #4: Trauma, Loss and Grief in First Responders Heightened by COVID-19 show art Mental Health Monthly #4: Trauma, Loss and Grief in First Responders Heightened by COVID-19

Emergency Medical Minute

Trauma and loss are common issues faced by emergency personnel and first responders. These challenges have since been heightened by the COVID-19 pandemic. On this installment of Mental Health Monthly, Anat ‘Nati’ Geva, PsyD, LP joins us to discuss the stages of grief in response to loss and trauma and how they pertain to first responders and frontline workers in particular. Each of the five stages of grief: denial, anger, bargaining, despair and acceptance are addressed and explained so you can expand your understanding of the natural process of grieving, identify signs and symptoms and...

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Contributor: Aaron Lessen, MD

Educational Pearls:

  • Supplemental oxygen is not a completely benign intervention. 
  • A recent meta-analysis found that O2 saturations above 96% while on supplemental O2 were associated with worse outcomes.
  • Only start a patient on supplemental oxygen if absolutely necessary and aim for a goal of no higher than 96%

References

Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Schünemann, John D Neary, Waleed Alhazzani. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet. Volume 391, Issue 10131. 2018. Pages 1693-1705,

 

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