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Podcast 655: Hypothermia in Sepsis

Emergency Medical Minute

Release Date: 04/06/2021

Podcast 684: Acidosis show art Podcast 684: Acidosis

Emergency Medical Minute

Contributor:  Nick Tsipis, MD Educational Pearls: pH <7.35 = acidemia; pH>7.45=alkalemia If pH low and pCO2 high, indicates a respiratory acidosis If pH low and pCO2 low, indicates metabolic acidosis After determining type of acidosis, check bicarb to determine compensation for acidosis and check electrolytes to calculate anion gap Metabolic acidosis can present with tachypnea (Kussmaul breathing) and hypotension due to loss of catecholamine function and suboptimal cardiac function at low pH Treat with IV fluids and address the underlying cause, limited role for bicarb References...

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Podcast 683: Zofran vs. Haldol for Cannabinoid Hyperemesis Syndrome show art Podcast 683: Zofran vs. Haldol for Cannabinoid Hyperemesis Syndrome

Emergency Medical Minute

Contributor:  Jared Scott, MD Educational Pearls: Around 30 patients with cannabinoid hyperemesis syndrome (CHS) randomized treatment in three arms with 8mg Zofran, Haldol 0.05 mg/kg, and Haldol 0.1 mg/kg Haldol arms performed better on all measures compared to Zofran Extrapyramidal symptoms were significantly higher in the Haldol group than Zofran, especially the high-dose Haldol group References Ruberto AJ, Sivilotti MLA, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Ann...

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Podcast 682: Snake Bites show art Podcast 682: Snake Bites

Emergency Medical Minute

Contributor:  Gretchen Hinson, MD Educational Pearls: Pit vipers include cottonmouths, rattlesnakes, and copperheads All have folding long fangs, triangular face, and elliptical pupils About 5,000 snakebites per year reported to Poison Control Initially develop a local reaction (swelling, bruising, pain, bullae) Complications can include  25% of snake bites result in no envenomation (dry bites) 20% of bites have serious side-effects, which can include hematologic, cardiovascular, neurologic and, muscular abnormalities, or even anaphylaxis to the envenomation itself Minor...

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Podcast 681: Internal Hernias show art Podcast 681: Internal Hernias

Emergency Medical Minute

Contributor:  Adam Barkin, MD Educational Pearls: Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery CT is very >90% sensitivity and specific in diagnosing SBO due to internal hernia Mesenteric swirl is a classic radiology...

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Podcast 680: Coronary Artery Dissection show art Podcast 680: Coronary Artery Dissection

Emergency Medical Minute

Contributor:  Adam Barkin, MD Educational Pearls: Spontaneous coronary artery dissection (SCAD) is the most common cause of acute MI in women under 50 years old Risk factors include fibromuscular dysplasia, extreme exercise, stress, pregnancy, and recent birth Diagnosed in cath lab but medically managed and usually do not get a stent Treated with dual antiplatelet therapy and beta-blockers References Yip A, Saw J. Spontaneous coronary artery dissection-A review. Cardiovasc Diagn Ther. 2015;5(1):37-48. doi:10.3978/j.issn.2223-3652.2015.01.08 Janssen EBNJ, de Leeuw PW, Maas AHEM....

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Podcast 679: Antibiotics for CAP show art Podcast 679: Antibiotics for CAP

Emergency Medical Minute

Contributor:  Peter Bakes, MD Educational Pearls: Community-acquired pneumonia (CAP) is normally stratified into outpatient-candidates vs. inpatient candidates for treatment For outpatient treatment, antibiotic selection is driven by presence or absence comorbid health conditions (chronic lung/kidney/liver disease, DM, immunocompromised state, alcoholism, asplenia) No comorbidities: High dose amoxicillin, doxycycline, azithromycin Comorbidities: augmentin, cephalosporin, doxycycline, macrolide with fluoroquinolones as an alternatives For inpatient treatment, standard treatment is a...

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Podcast 678: ECMO for Refractory VFib show art Podcast 678: ECMO for Refractory VFib

Emergency Medical Minute

Contributor:  Aaron Lessen, MD Educational Pearls: Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac cath vs. typical resuscitation After 30 patients (15 each arm), the trial was stopped because such a significant benefit seen in the ECMO arm 6 patients survived and 3 had good neurological outcomes at 6 months with ECMO This is compared to 1 patient surviving initially and none surviving at 6 months in the typical resuscitation arm References Yannopoulos D, Bartos J, Raveendran G, et al....

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Podcast 677: Oatmeal Cream for Hand Eczema show art Podcast 677: Oatmeal Cream for Hand Eczema

Emergency Medical Minute

Contributor:  Jared Scott, MD Educational Pearls: Hand eczema is present in about 10% of the population and has a great prevalence in hairdressers, healthcare workers, and food service employees Using 1% oatmeal cream instead of a base cream showed statistically significant improvement in outcomes of HE in healthcare workers in a double-blind study References Sobhan M, Hojati M, Vafaie SY, Ahmadimoghaddam D, Mohammadi Y, Mehrpooya M. The Efficacy of Colloidal Oatmeal Cream 1% as Add-on Therapy in the Management of Chronic Irritant Hand Eczema: A Double-Blind Study. Clin Cosmet Investig...

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Podcast 676: Spontaneous Bacterial Peritonitis show art Podcast 676: Spontaneous Bacterial Peritonitis

Emergency Medical Minute

Contributor:  Sam Killian, MD Educational Pearls: Patients with cirrhosis and ascites are frequently evaluated for spontaneous bacterial peritonitis, an infection of the ascites fluid that is not from a surgically treated source Fever, abdominal pain, and altered mental status should all raise clinical suspicion in a patient with ascites Fluid from paracentesis may show increased WBCS (polys and neutrophils), high LDH, high amylase, and decreased glucose Outcomes are very poor in these patients with 30-40% of these patients continue to renal failure with 60-80% in-hospital mortality...

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Pharmacy Phriday #10: Colorado Pharmacists Association 2020 Opioid Prescribing and Treatment Guidelines show art Pharmacy Phriday #10: Colorado Pharmacists Association 2020 Opioid Prescribing and Treatment Guidelines

Emergency Medical Minute

This week's Pharmacy Phriday features a short excerpt from a longer podcast released as promo for the Colorado's CURE initiative, Clinicians United to Resolve the Epidemic, that combats the opioid crisis through education. Frequent contributor to the podcast, Rachael Duncan, PharmD, is joined by host, Elizabeth Esty, MD, to discuss the opioid prescribing guidelines for pharmacists released by the Colorado Hospital Association in collaboration with the Colorado Pharmacists Society. Colorado's CURE focuses on four pillars: Limiting the use of opioids in clinical practice Using multimodal...

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More Episodes

Contributor: Adam Barkin, MD

Educational Pearls:

  • Fever is an adaptive response to infection, but elderly and immunocompromised patients may not be able to mount a hyperthermic response in sepsis
  • Patients with fever in sepsis end up receiving treatment earlier and have better outcomes
  • Hypothermic patients with severe sepsis admitted to the ICU had a 32% mortality versus 21% mortality in those who had a fever on presentation
  • 3-hour sepsis bundle compliance was less frequent in hypothermic patients than in febrile patients (56% versus 71%)
  • Early broad spectrum antibiotics were administered less in patients who were hypothermic than those that were febrile (77% versus 87%)

References

Blair E, Buxton RW, Cowley RA, Mansberger AR. The Use of Hypothermia in Septic Shock. JAMA. 1961;178(9):916–919. doi:10.1001/jama.1961.73040480005008b

Kushimoto S, Abe T, Ogura H, et al. Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study. Crit Care Med. 2019;47(5):691-699.

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

 

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