loader from loading.io

Podcast 592:  Rapid Antihypertensives

Emergency Medical Minute

Release Date: 09/01/2020

Pediatric Emergencies Brewcast: Common Respiratory Conditions in Pediatric Patients show art Pediatric Emergencies Brewcast: Common Respiratory Conditions in Pediatric Patients

Emergency Medical Minute

Emergency Medical Minute collaborated with CarePoint Health in early March for a night of education on Pediatric Emergencies geared towards mid-level providers 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 when dealing with respiratory illnesses across different age ranges.  Dr. Parisa Jamshidi, Pediatric Emergency Physician, reviews common respiratory illnesses including bronchiolitis, croup and bacterial tracheitis in pediatric patients covering their presentation...

info_outline
Podcast 606: The Oxygen Wars show art Podcast 606: The Oxygen Wars

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: The use of oxygen is controversial when treating patients with certain conditions, like MI’s, stokes, or ARDS because adverse outcomes have been demonstrated with using high oxygen concentrations. The Oxygen ICU trial looked at using higher and lower oxygen levels in treating intubated ARDS patients and found that mortality was improved when less oxygen was given allowing oxygen saturations to sit around 95% versus using high oxygen levels to obtain 100% blood oxygen saturation. The LOCO trial tested using even lower oxygen concentrations...

info_outline
Podcast 605: Acute Limb Ischemia show art Podcast 605: Acute Limb Ischemia

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Classically presents with the 6Ps: Pain, pallor, paresthesia, pulseless, poikilothermia (cold), and paralysis Acute limb ischemia occurs by embolic or thrombotic causes Thrombotic causes are now more common due to aging populations and advancements in vascular surgery like stents which can be a nidus for thrombosis. Sudden onset of pain without prior symptoms is more typical of embolic causes Preceding symptoms leading to acute ischemia are more often from thrombosis Diagnosis can be clinical based on absent pulses, ultrasound or CT angiogram...

info_outline
On the Streets #9: Advanced Applications of Capnography show art On the Streets #9: Advanced Applications of Capnography

Emergency Medical Minute

Capnography is the measurement of the partial pressure of exhaled CO2 and is an indirect measurement of your cellular respiration. It is displayed visually as a block-like waveform during the exhalation phase of respiration and monitors ventilation in real-time. Capnography is the gold standard for monitoring sedated and intubated patients in the hospital and the field and can be used in many other situations to discern more information about your patient. Our host Jordan Ourada is joined by Dr. Eric Hill who is a board certified Emergency Physician, EMS Director for 9 agencies around...

info_outline
Podcast 604: Baclofen Withdrawal show art Podcast 604: Baclofen Withdrawal

Emergency Medical Minute

Contributor: Erik Verzemnieks, MD Educational Pearls: Baclofen is used to treat muscle spasms or spasticity. Baclofen comes in two forms: oral and intrathecal Withdrawal is much more common with those receiving intrathecal administration from a Baclofen pump, which is typically spinal cord patients Withdrawal symptoms usually start within 1-3 days after stopping baclofen Symptoms include altered mental status, muscle rigidity, and fevers, which can mimic other severe illnesses It is nearly impossible to reverse withdrawal symptoms with oral baclofen if a patient is receiving it intrathecally,...

info_outline
Podcast 603: Don't Sedate. Block. show art Podcast 603: Don't Sedate. Block.

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Fractures and dislocations that require reduction do not necessarily require sedation  Nerve blocks are an effective alternative that can provide analgesia to reduce fractures and dislocations and provide sustained pain relief after the reduction is completed Hematoma blocks are effective for distal radius and various ankle fractures Shoulder dislocations can be reduced by performing a scapular nerve block References Tezel O, Kaldirim U, Bilgic S, Deniz S, Eyi YE, Ozyurek S, Durusu M, Tezel N. Am J Emerg Med. 2014 Jun;32(6):549-52. doi:...

info_outline
Podcast 602: Post-Narcan Observation show art Podcast 602: Post-Narcan Observation

Emergency Medical Minute

Contributor: Donald Stader, MD Educational Pearls: Not uncommon for patients presenting after opiate overdose and narcan administration to be observed for 4-6 hours This has been based more on tradition than evidence Observation periods for overdose may vary based on the opiate(s) used Fentanyl and heroin have half lives of about 2 hours, while oxycodone and methadone have significantly longer half lives.  HOUR trial attempted to externally validate a scoring tool for stratification of low risk patients appropriate for discharge after 1 hour References Clemency BM, Eggleston W, Shaw EW,...

info_outline
Podcast 601: Droperidol show art Podcast 601: Droperidol

Emergency Medical Minute

Contributor: Sam Killian, MD Educational Pearls: Droperidol (Inapsine) is an antipsychotic drug with efficacy for  nausea, vomiting, headaches, and treating agitation In the early 2000’s, Droperidol received a black box warning for QT prolongation This caused a precipitous drop of in administration and ultimately led to a stop in production More careful analysis since has called into question the true incidence of QT prolongation in typical dosing Retrospective review published this year looked at 15,374 non-critical and 1,172 critical patients who received droperidol with only a...

info_outline
Pediatric Emergencies Brewcast: Pediatric Fever show art Pediatric Emergencies Brewcast: Pediatric Fever

Emergency Medical Minute

Emergency Medical Minute collaborated with CarePoint Health in early March for a night of education on Pediatric Emergencies geared towards mid-level providers 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 when dealing with fevers across different age ranges. With flu season around the corner, now is a good time to brush up on your knowledge surrounding pediatric fevers. Dr. Leslie Tourangeau, Pediatric Emergency Medicine Physician, breaks down what qualifies as a fever...

info_outline
Podcast 600: Penicillin Allergy? show art Podcast 600: Penicillin Allergy?

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: True allergies to penicillin compared to reported allergies from patients ranges around 10% Recent study took patients undergoing sensitivity tests and developed the PEN(icillin)-FAST score to address reported penicillin allergies PEN-FAST has four components for a total score of 0-4: o   F = five years or less since prior reaction. o   A = Angioedema/Anaphylaxis. o   S = Severe cutaneous reaction (rash). o   T = Treatment, did they require treatment for a reaction? Patients with a  score of 0 had <1% incidence of...

info_outline
 
More Episodes

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 onset and short duration of action making it easily titratable
    • Hydralazine: direct arterial dilator;  patient dependent response that can be unpredictable. Use with caution in patients with CAD or an aortic dissection because there will be a reflexive increase in heart rate to combat the arteriolar dilation.
  • Calcium Channel Blockers
    • Nicardipine: Given as an IV infusion starting at 5g/hr up to 15g/hr. This drug has a slower onset of action making it difficult to titrate and it has a longer serum elimination half-life (3-6 hours)
    • Clevidipine: rapid onset and short duration of action;  Reduces BP without affecting cardiac filling pressures but can cause reflex tachycardia

References

)Wani-Parekh P, Blanco-Garcia C, Mendez M, Mukherjee D. Guide of Hypertensive Crisis Pharmacotherapy. Cardiovasc Hematol Disord Drug Targets. 2017;17(1):52-57. doi:10.2174/1871529X16666161220142020

Suneja M, Sanders ML. Hypertensive Emergency. Med Clin North Am. 2017;101(3):465-478. doi:10.1016/j.mcna.2016.12.007

Maloberti A, Cassano G, Capsoni N, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. High Blood Press Cardiovasc Prev. 2018;25(2):177-189. doi:10.1007/s40292-018-0261-4

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