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Podcast 737: TBI Outcomes

Emergency Medical Minute

Release Date: 12/13/2021

Podcast 782: Ventilator Management show art Podcast 782: Ventilator Management

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Tidal volume is the amount of breath a patient receives in a single ventilation  Traditional tidal volume (TV) setting was 10 ml/kg but studies showed lower TV had less incidence of respiratory distress, ARDS, and overall better outcomes  ED ventilation settings may get carried on for hours or days when a patient is admitted, making this an important part of patient care Recent large systematic review shows that low TV setting in the ED leads to decreased incidence of ARDS, shorter ICU and hospital length of stay, shorter duration of...

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Podcast 781: Foxglove, Dropsy, and Salvador Dali show art Podcast 781: Foxglove, Dropsy, and Salvador Dali

Emergency Medical Minute

Contributor: Chris Holmes, MD Educational Pearls: Foxglove plant contains the cardiac glycoside digoxin   Foxglove leaf potions were once used to treat Dropsy; a historic term for symptoms of heart failure  Digoxin, previously used for treating heart failure, works by increases heart contraction strength and slows heart rate Of note, the EKG of patient on digitalis may have a ‘Dali Mustache’ appearance Digoxin toxicity can lead to a variety of dysrhythmias as well as neurological, GI, and metabolic effects Treatment of digoxin toxicity is digoxin-immune fab, which is an...

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Podcast 780: Pediatric Sedation Post-Intubation show art Podcast 780: Pediatric Sedation Post-Intubation

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Recent study looking at a pediatric emergency department to determine what percentage of patients after intubation received sedation within 10 minutes after intubation About 25% of the patients in the study received sedation within 10 minutes after intubation Only 75% of the patients in the study received sedation in the ED at some point after intubation Those who received rocuronium were less likely to received sedation post-intubation References Berg K, Gregg V, Cosgrove P, Wilkinson M. The Administration of Postintubation Sedation in the...

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Podcast 779: Pulse Pressure in Trauma show art Podcast 779: Pulse Pressure in Trauma

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Pulse pressure is the difference between the systolic and diastolic blood pressure, normal is about 40 A narrow pulse pressure is generally thought of as less than 30 mmHg which may signal peripheral vasoconstriction in response to lower blood volumes 2020 study examined hypotension and narrow pulse pressure in trauma and outcomes 37% of patients who were hypotensive on ED arrival had a severe injury, 22% of patients who had a narrow pulse pressure had a severe injury, and 11% of patients with normal blood pressure and normal pulse pressure...

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Podcast 778: tPA for Frostbite Injury show art Podcast 778: tPA for Frostbite Injury

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Mild frostbite injury usually only requires supportive care In severe frostbite injury, patients should receive an immediate angiogram, be admitted, and receive tPA if there is evidence of vascular occlusion Salvage rate is around 80% for appropriate patients who receive tPA in phalangeal frostbite injury References Paine RE, Turner EN, Kloda D, Falank C, Chung B, Carter DW. Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates. Burns Trauma. 2020;8:tkaa008. Published 2020 Apr 10. doi:10.1093/burnst/tkaa008 Basit H,...

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Podcast 777: Grass, Weed, and Ancient Rome show art Podcast 777: Grass, Weed, and Ancient Rome

Emergency Medical Minute

Contributor: Chris Holmes, MD Educational Pearls: Antiemetics were used in ancient Rome to help with sea-sickness and included toxic substances such as wine and wormwood and white hellborn The first antihistamine used for nausea, dramamine, was introduced in 1947 for motion sickness After this chlorpromazine, prochlorperazine, and promethazine came about in the 1950s and 1960s Cannabis, colloquially referred to as weed, isolates like THC used in the 1970s to help with chemotherapy-induced After this in the 1980s, ondansetron and metoclopramide were introduced for more severe...

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Mental Health Monthly #12: Management of Opioid Use Disorder with MAT (Medication-Assisted Treatment) show art Mental Health Monthly #12: Management of Opioid Use Disorder with MAT (Medication-Assisted Treatment)

Emergency Medical Minute

In this special episode of MHM, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the implications of OUD in Colorado. As a substance use disorder specialist, Dr. Haddad provides an invaluable perspective on various treatment modalities for OUD in the outpatient and inpatient settings. Finally, Dr. Haddad and Dr. Dhaliwal discuss the implications of the newly introduced Colorado legislation affecting patients with OUD and their providers.    Key Points:   The classic Suboxone therapy for heroin or...

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Podcast 776: Single-Site Blood Cultures show art Podcast 776: Single-Site Blood Cultures

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Traditionally, blood cultures are drawn from two separate sites despite no data to suggest this is better than drawing blood from one site Recent study evaluated multi-site versus single-site blood cultures to determine if there was a difference in accuracy or contamination Positive yield was 20% in the single-site year and 17% in the multi-site year No difference in contamination between the two groups References Ekwall-Larson A, Yu D, Dinnétz P, Nordqvist H, Özenci V. Single-Site Sampling versus Multisite Sampling for Blood Cultures: a...

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Podcast 775: Olecranon Bursitis show art Podcast 775: Olecranon Bursitis

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Olecranon bursitis refers to inflammation in the bursa of the elbow and can be due to infection or trauma Recent study examined treating suspected septic olecranon bursitis with antibiotics versus drainage About 90% of the patients treated with antibiotic therapy for this issue did not require subsequent drainage or hospitalization for intravenous antibiotics Consider treating suspected olecranon bursitis with antibiotic therapy and good return precautions rather than defaulting to drainage References Beyde A, Thomas AL, Colbenson KM, et al....

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On the Streets #13: Pre-hospital Cardiology Concepts show art On the Streets #13: Pre-hospital Cardiology Concepts

Emergency Medical Minute

On this episode of On the Streets, our host, Jordan Ourada, talks with cardiologist, Dr. Chirag Chauhan, about all things cardiac. Highlighted topics: Wrist versus femoral access in the cath lab The most important prehospital interventions for an MI  Nitroglycerin: Who gets it and what are the precautions Lidocaine and amiodarone in a heart attack  CPR assist devices

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More Episodes

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Study evaluating patient outcomes after traumatic brain injury (TBI) over 1 year
  • Trial followed patients with severe TBI (GCS 3-8) and moderate TBI (GCS 9-12)
  • At 1 year out ½ of the severe TBI group were able to be independent for at least 8 hours per day; ⅔ were independent to this level at one year in the moderate TBI group
  • ¼ of the patient who were in a vegetative state 2 weeks after the traumatic brain injury had good outcomes at 1 year

References

McCrea MA, Giacino JT, Barber J, et al. Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study. JAMA Neurol. 2021;78(8):982-992. doi:10.1001/jamaneurol.2021.2043

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

 

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