Podcast 871: Increased Intracranial Pressure and the Cushing Reflex
Emergency Medical Minute
Contributor: Travis Barlock MD Education Pearls: The Cushing Reflex is a physiologic response to elevated intracranial pressure (ICP) Cushing’s Triad: widened pulse pressure (systolic hypertension), bradycardia, and irregular respirations Increased ICP results from systolic hypertension, which causes a parasympathetic reflex to drop heart rate, leading to Cushing’s Triad. The Cushing Reflex is a sign of herniation Treatment includes: Hypertonic saline is comparable to mannitol and preferable in patients with hypovolemia or hyponatremia Give 250-500mL of 3%NaCl ...
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On The Streets #15: Hydrofluoric Acid Case Review
Emergency Medical Minute
Contributors: Kalen Abbott, MD - EM Physician and Medical Director for AirLife Denver Brendan Reiss - Flight Nurse AirLife Denver Matt Spoon - Flight Paramedic AirLife Denver Jordan Ourada - EMS Coordinator at Swedish Medical Center and Paramedic Summary: In this episode, hosted by Jordan Ourada, Brendan Reiss and Matt Spoon present a first-hand experience case of hydrofluoric acid exposure in a pediatric patient. Commentary and educational pearls are provided by EM Physician, Kalen Abbott. The case: The patient was a male infant who had spilled a large amount of heavy-duty...
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Episode 870: Advanced Trauma Life Support (ATLS)
Emergency Medical Minute
Contributor: Meghan Hurley MD Educational Pearls: What is ATLS? Advanced Trauma Life Support (ATLS) is a systematic and comprehensive approach to the evaluation and management of trauma patients It was developed by the American College of Surgeons (ACS) The key components include the Primary Survey ("ABCDE"), the Secondary Survey, Definitive Care, and Special Considerations What are the issues with ATLS? ATLS relies on many algorithms and rules-of-thumb, which might be helpful for individuals with basic skills and training but might actually present obstacles for those with higher...
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Podcast 869: Shift Work
Emergency Medical Minute
Contributor: Meghan Hurley MD Educational Pearls: Shift work is defined as anything that takes place outside of a 9-5 schedule, not exempting day-shift medical workers Various ill effects of shift work on overall health: Increased all-cause mortality Increased number of accidents Glucose metabolism dysregulation Increased BMI Fertility impacts for men and women Increased breast cancer risk Decreased cognitive functioning Mitigation strategies Work at the same time every day Anchor Sleep - always try to be asleep at the same time of day Progressive shifts: day- into...
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Episode 868: Airway Management in Obesity
Emergency Medical Minute
Contributor: Aaron Lessen MD Educational Pearls: Why is airway management more difficult in obesity? Larger body habitus causes the chest to be above the head when the patient is lying supine, creating difficult angles for intubation. Reduced Functional Residual Capacity (FRC) causes these patients to deoxygenate much more quickly, reducing the amount of time during which the intubation can take place. What special considerations need to be made? Positioning. The auditory canal and sternal notch should be aligned in a horizontal plane. Do this by stacking blankets to lift the neck and...
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Episode 867: Occult Scaphoid Fractures
Emergency Medical Minute
Contributor: Nick Tsipis MD Educational Pearls: The scaphoid bone is the most proximal carpal bone just distal to the radius Fractures of the scaphoid bone are sometimes missed by plain X-rays A 2020 review found a 21.8% incidence of missed scaphoid fractures later diagnosed by advanced imaging modalities Only MRI has a sensitivity above 90% for diagnosing scaphoid fractures Sensitivity of plain-film radiography is low unless it is a displaced fracture Physical examination techniques fail to definitively rule out scaphoid fractures A 2023 systematic review assessed the...
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Podcast 866: Carbamazepine (Tegretol) Overdose
Emergency Medical Minute
Contributor: Aaron Lessen MD Educational Pearls: What is Carbamazepine (Tegretol)? Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, epilepsy, and neuropathic pain. It functions primarily by blocking sodium channels which can prevent repetitive action potential firing. What are the symptoms of an overdose? Common initial signs include diminished conscious state, nystagmus, ataxia, hyperreflexia, CNS depression, dystonia, and tachycardia Severe toxicity can cause seizures, respiratory depression, decreased myocardial...
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Laboring Under Pressure- Episode 1. ACLS in Pregnancy with Dr. Jason Papazian
Emergency Medical Minute
Contributor: Jason Papazian MD, Travis Barlock MD, Jeffrey Olson Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss several clips from Dr. Jason Papazian’s talk at the event “Laboring Under Pressure, Managing Obstetric Emergencies in a Global Setting” from May 2023. This event was hosted at the University of Denver and was organized with the help of Joe Parker as a fundraiser for the organization Health Outreach Latin America (HOLA). Dr. Jason Papazian practices Obstetric Anesthesiology for the Maternal Fetal Care Unit at Children's...
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Podcast 865: Nausea Treatments - Droperidol vs Ondansetron RCT
Emergency Medical Minute
Contributor: Aaron Lessen MD Educational Pearls: A recent randomized controlled trial compared ondansetron 8 mg IV with droperidol 2.5 mg IV for the treatment of nausea & vomiting in the emergency department. Overall, droperidol and ondansetron had similar primary outcomes in acute nausea control Symptom improvement in 93% of patients receiving droperidol vs. 87% receiving ondansetron (P = 0.362) Secondary measures were, however, statistically significantly different between groups Patients needed fewer rescue/additional antiemetics in the droperidol group (16%)...
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Podcast 864: Arterial Blood Gas (ABG) vs Venous Blood Gas (VBG)
Emergency Medical Minute
Contributor: Aaron Lessen MD Educational Pearls: What is measured in an ABG/VBG? Blood values for oxygen tension (pO2), carbon dioxide tension (pCO2), acidity (pH), oxyhemoglobin saturation, and bicarbonate (HCO3) in either arterial or venous blood Other tests can measure methemoglobin, carboxyhemoglobin, hemoglobin levels, base excess, and lactate What are they used for? Identification of ventilation/acid-base disturbances. For example: if a patient is in septic shock, oxyhemoglobin saturation can be used to guide resuscitation efforts (early goal- directed therapy) What's the...
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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
Burger MK, Schaller DJ. Metabolic Acidosis. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
Cadogan M. Acid Base Disorders. Life in the Fast Lane • LITFL. https://litfl.com/acid-base-disorders/. Published November 3, 2020. Accessed June 23, 2021.
Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
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