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Podcast 586:  Toxic Shock Syndrome

Emergency Medical Minute

Release Date: 08/11/2020

Podcast 633: Pathologic Femur Fractures    show art Podcast 633: Pathologic Femur Fractures   

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Pathologic bone fractures occur due to weakened bones from chronic disease and with less force when compared to non-pathologic fractures Can be due to bone tumors, bone cysts, infections (osteomyelitis), osteogenesis imperfecta, Paget's disease of bone, and multiple myeloma Have moth bitten or lytic appearance and you can sometimes see the periosteum peeling away from the bone References Angelini A, Trovarelli G, Berizzi A, Pala E, Breda A, Maraldi M, Ruggieri P. Injury. 2018 Nov;49 Suppl 3:S77-S83. doi: 10.1016/j.injury.2018.09.044. PMID:...

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Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Hyperacute T waves can occur immediately and typical last less than an hour Hyperacute T waves are typically broader than peaked T-waves, which are associated with hyperkalemia ST elevation which usually starts within an hour of the inciting event and can last up to a few days, and often follows the hyperacute T-waves Q waves can begin at the time ST elevation begins and can remain permanently T waves can invert before normalizing again days later References Levis JT. . Perm J. 2015;19(3):79. doi:10.7812/TPP/14-243 Vogel B, Claessen BE,...

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Podcast 629: Inferior STEMI show art Podcast 629: Inferior STEMI

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: EKGs look at different angles, or vectors, of the heart’s electrical conduction as it travels through the heart. Knowing how to read these vectors is essential in diagnosing locations of cardiac pathologies  Leads II, III, and aVF follow an inferior path, so ST elevation in those leads indicates inferior involvement Major complications more common with inferior STEMIs can include:  hypotension which can be made worse by nitroglycerin Severe bradycardia due to SA/AV node involvement Inferior STEMI, barring no hypotension or...

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Podcast 628: ST Elevation show art Podcast 628: ST Elevation

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: STEMI criteria is not just 1mm elevation in contiguous leads 1.5 mm in V2-V3 for women 2.0 mm in V2-V3 for men 2.5 mm in V2-V3 for men under 40 Inferior MI typically have ST elevation in leads II, III and aVF Usually inferior MI’s show reciprocal changes (ST depression) in the lateral leads. Lateral MI typically elevation in V5, V6, I, and aVL Anterior MI show elevation in leads V1-4 Right sided MIs have mixed pattern, showing elevation in V1-V2 and V4 along with the inferior leads. Right sided MI’s are very sensitive to nitrates,...

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Podcast 627: Oxygen Like It’s Hot show art Podcast 627: Oxygen Like It’s Hot

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: High flow nasal cannula (HFNC) has become more utilized with COVID pandemic Multiple studies have shown this method improves both oxygenation and ventilation Newer studies have shown the respiratory benefit of HFNC  vs normal oxygen in patients suffering from CHF and those with do not intubate orders who are experiencing respiratory distress.   Heated high flow is another option to provide ventilator and oxygen support to patients who either do not need or do not want to be intubated References Kang MG, Kim K, Ju S, et al. . J...

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Pharmacy Phriday #6: Tik Tok Benadryl Challenge and Diphenhydramine Toxicity show art Pharmacy Phriday #6: Tik Tok Benadryl Challenge and Diphenhydramine Toxicity

Emergency Medical Minute

Contributor: Ruben Marrero-Vasquez, PharmD Educational Pearls: ACEP and FDA have both issued warnings about the viral Tik Tok Benadryl (diphenhydramine) challenge where individuals voluntarily overdose on diphenhydramine which can cause fatal toxicity Diphenhydramine is typically dosed at 0.5-1 mg/kg in pediatric patients Q4-6 PRN and carries a fatal dose of 20-40 mg/kg but anywhere from 3-5x recommended dose does can cause toxicity Diphenhydramine toxicity causes both central and peripheral anticholinergic toxicity Central anticholinergic toxicity symptoms: delirium, agitation,...

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Mental Health Monthly #6: Suicide Assessment show art Mental Health Monthly #6: Suicide Assessment

Emergency Medical Minute

EMM is excited to welcome back the hosts of Millennial Mental Health Channel podcast to explain the key points of a robust suicide assessment in the ED. Dr. Justin Romano is a third year psychiatry resident in Omaha, Nebraska and Eddie Carrillo is a licensed mental health therapist currently working at partial hospitalization and IOP eating disorder program in Portland, Oregon. Their podcast Millennial Mental Health Channel seeks to explore the world of mental health from their two professional perspectives. You can listen to their podcast on all major streaming platforms...

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More Episodes

Contributor: Don Stader, MD

Educational Pearls:

  • Toxic shock syndrome (TSS) is a rare cause of shock typically caused by Staph aureus or Strep pyogenes, that produces a toxin that leads to rapid onset hypotension with a diffuse erythematous rash.
  • Signs of TSS may include rapid onset of altered mental status, dizziness, nausea, abdominal discomfort, hypotension, and rash
  • TSS is associated with foreign bodies, such as tampons or nasal packing - make sure to remove any offending object
  • Clindamycin is the drug of choice because it stops protein synthesis which helps treat toxic shock because toxic shock is caused by a protein (TSST-1) made by the bacteria.  
  • TSS is associated iwth high morbidity and mortality despite treatments
  • Despite the association with TSS, there is little supporting evidence for prophylactic antibiotics when placing nasal packing

References

Gottlieb M, Long B, Koyfman A. The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature. J Emerg Med. 2018;54(6):807-814. doi:10.1016/j.jemermed.2017.12.048

Lange JL, Peeden EH, Stringer SP. Are prophylactic systemic antibiotics necessary with nasal packing? A systematic review. Am J Rhinol Allergy. 2017;31(4):240-247. doi:10.2500/ajra.2017.31.4454

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD