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Podcast 690: Rectal Oxygen. Nice,

Emergency Medical Minute

Release Date: 07/07/2021

Podcast 714: Intradermal Sterile Water for Back Pain show art Podcast 714: Intradermal Sterile Water for Back Pain

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Randomized controlled-trial evaluated intradermal injections of sterile water to manage low back pain versus an IV NSAID Four intradermal injections of 0.1 cc sterile water in a square around the area of musculoskeletal pain Reduction of pain was 7 points with the procedure and 2 points with the IV NSAID at 24 hours 12% in the injection group versus 50% in the IV NSAID group needed opioids 87% patient satisfaction in the injection group versus 16% patient satisfaction in the IV NSAID group References Tekin E, Gur A, Bayraktar M, Ozlu I, Celik...

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Podcast 713: Oral Ketamine show art Podcast 713: Oral Ketamine

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Those on chronic opioid therapy may have high tolerance to opioids and/or opioid hyperalgesia Ketamine is a good adjunct for pain control in patients on chronic opioid therapy To avoid the time constraints often required to push ketamine intravenously, it can be given orally: Ketamine IV 25-50 mg (~0.01-0.03 mg/kg) as a single dose by mouth References Blonk M, Koder B, et al. Use of oral ketamine in chronic pain management: A review. European Journal of Pain. 2009. Schwenk ES, et al. Consensus guidelines on the use of intravenous ketamine...

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Podcast 712: Cephalosporin with a Penicillin Allergy show art Podcast 712: Cephalosporin with a Penicillin Allergy

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study in the Kaiser system looked at over 4 million patients receiving antibiotics to determine the effect of penicillin allergy prompts in the EHR on antibiotic prescribing Half of the sites removed prompts stating penicillin allergy and half kept the prompts Patients with penicillin allergies who received cephalosporins went up from 20% to 27% in areas where the prompt was remove No difference in mortality or no new allergies found between the two groups Reduced the use of fluoroquinolones and clindamycin in the group...

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On the Streets #10: IO Administration Gone Awry show art On the Streets #10: IO Administration Gone Awry

Emergency Medical Minute

Dr. Glenda Quan, trauma surgeon from Swedish Medical Center joins our host Jordan Ourada to review a case of an incorrectly placed IO and how to avoid it. The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.

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Podcast 711: Insulin Pumps show art Podcast 711: Insulin Pumps

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Insulin pumps provide a continuous infusion of fast-acting insulin using a basal rate and bolus prior to meals Some connect to a continuous glucometer but often blood glucose needs to be checked manually Hypoglycemia is rarely due to a malfunctioning pump - there is usually an another external factor Hyperglycemia can be caused by underdosing, illness, pump malfunction or expired insulin The pump can be used to give a bolus of insulin in the emergency department if necessary Stopping the  device can be done manually on the device or...

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Podcast 710: Droperidol vs. Zyprexa show art Podcast 710: Droperidol vs. Zyprexa

Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about 16 minutes for both agents Droperidol was slightly less sedating than olanzapine and length of stay for olanzapine was longer Olanzapine had a higher rate of requiring another agent for adequate sedation Droperidol had a higher rate of adverse events (mainly extrapyramidal symptoms) than olanzapine Remember to put the safety of the staff and patient at the forefront of sedation practices and be...

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Podcast 709: Clown Therapy show art Podcast 709: Clown Therapy

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Using LET, procedural sedation, and distraction techniques are often needed to successfully perform painful procedures in pediatrics patients The technique of clown therapy has been studied as an adjunct to LET and other distraction techniques for procedures in pediatric patients One randomized-controlled trial from 2016 found anxiety was greatly reduced using medical clown therapy to aid in painful procedures in pediatrics patients References Felluga M, Rabach I, Minute M, et al. A quasi randomized-controlled trial to evaluate the...

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Podcast 708: Diagnostic Paracentesis show art Podcast 708: Diagnostic Paracentesis

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Paracentesis is a procedure where fluid is removed from the peritoneal cavity by needle Indications for paracentesis include: large volume paracentesis (5-6L), diagnosis of transudative or exudative ascites, evaluation for spontaneous bacterial peritonitis (SBP) Infection of ascitic fluid is more likely in transudative processes due to the increased frequency of paracentesis E coli is the most common pathogen to cause SBP Treatment with 3rd generation cephalosporin, like ceftriaxone References Summarized by John Spartz, MS4 | Edited by Erik...

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Podcast 707: Sigmoid Volvulus show art Podcast 707: Sigmoid Volvulus

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Sigmoid volvulus occurs when the sigmoid colon twists 180 to 360 degrees 10% of intestinal obstructions in the US; 50-70% of intestinal obstructions worldwide More common in elderly patients with chronic constipation Eventually may lead to bowel perforation, a surgical emergency Treatment is sigmoidoscopy or sigmoid colectomy References Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access...

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Podcast 706: Pepper Spray Decon show art Podcast 706: Pepper Spray Decon

Emergency Medical Minute

  Contributor: Ramnik Dhaliwal, MD JD Educational Pearls: Pepper spray is a highly irritating compound with active ingredient of capsaicin Techniques to help decontaminate and alleviate symptoms of an exposure include: Disrobing the patient to prevent further exposure Half milk of magnesia and half water mixture can be used to soothe the skin in the area of exposure Proparacaine followed by Morgan lens to irrigate the eye in adults Nasal cannula connected to a liter of normal saline can passively irrigate the eye in small children and other less than cooperating patients References...

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More Episodes

Contributor: Chris Holmes, MD

Educational Pearls:

  • In the 1700s, boxes lined the River Thames to pump smoke up the rectum to resuscitate people who had been found unconscious in the river
  • Sea cucumbers can extract oxygen through their rectum
  • Perflourocarbon, a liquid that can become oxygenated, provided rectally was able to oxygenate pigs and mice in a recent study

References

Okabe R, Chen-Yoshikawa T, Yoneyama Y, et al. Mammalian enteral ventilation ameliorates respiratory failure. Clinical and Translational Resource and Technology Insights. 2021;2(6):773-783. doi:https://doi.org/10.1016/j.medj.2021.04.004

 

The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.org/cme-courses/ and create an account. 

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