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UnfilterED #10: Debi Smith

Emergency Medical Minute

Release Date: 09/23/2020

Podcast 608: Another Elevated Lactate? show art Podcast 608: Another Elevated Lactate?

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Lactate is a byproduct of anaerobic metabolism or tissue hypoperfusion Though typically associated with severe sepsis, hyperlactatemia can be caused by vigorous exercise, seizures, liver failure, asthma exacerbations, albuterol, metformin, antiretroviral drugs, and propofol Liver failure can lead to an inability to clear lactate, or convert it back to glucose byproducts, instead of an overproduction of lactate Always remember the other causes of elevated lactic acid besides sepsis but also remember sepsis! References: Kraut JA, Madias NE. . N...

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Podcast 607: Is Pain the Enemy? show art Podcast 607: Is Pain the Enemy?

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Pain is ubiquitous in the emergency department but it is not the enemy - suffering is Nociception is the ability to feel noxious stimuli which usually causes a reaction, like pulling a limb away when you feel something painful. Nociception is really a brainstem reflex. Pain is nociception plus cognition, meaning we process the noxious stimuli in our frontal cortex but it is not necessarily suffering.  Pain can be associated with euphoria, such as with distance running Suffering, unlike pain, is associated with emotional distress Nociception...

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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...

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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...

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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...

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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...

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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,...

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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:...

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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,...

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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...

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More Episodes

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 Evolution of healthcare law

5:00 Contracts

9:36 Independent medical decision making without influence from a corporation

11:00 Importance of protecting your ideas

12:30 How to navigate litigation

15:09 Choosing to be an expert witness

15:56 Malpractice

17:22 common mistakes with subpoenas

18:56 COVID

22:01 Advice to getting involved in healthcare law