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Podcast 743: Rust Rings

Emergency Medical Minute

Release Date: 01/03/2022

Podcast 784: Wastewater Surveillance for COVID show art Podcast 784: Wastewater Surveillance for COVID

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: About 50% of those infected with SARS-CoV-2 will shed the virus in their feces   Wastewater surveillance can be used to track COVID burden, which may be easier than collating test data from multiple hospitals across a region  Viral shedding begins 5-7 days prior to symptom onset, so wastewater data can be used to anticipate outbreaks and inform policy and public health initiatives  Some existing limitations to wastewater surveillance include: Reporting by counties were water sources may be mixed Septic tanks and other closed...

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Podcast 783: LAD Occlusion & Troponin show art Podcast 783: LAD Occlusion & Troponin

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: A study randomized 34 healthy patient to have their left anterior descending artery (LAD) occluded by balloon for 0, 15, 30, or 90 seconds   Subsequently,  cardiac troponins (cTns) and Copeptin were measured every 15 minutes for 3 hours, then every 30 minutes for the next 3 hours 5 conclusions were drawn: Copeptin is not a useful marker of cardiac ischemia  cTn may be detected after only 30 seconds of ischemia  cTn may be detected in a little as 15 minutes after ischemic event  After only 90 seconds of ischemia,...

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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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More Episodes

Contributor: Jared Scott, MD

Educational Pearls:

  • A rust ring can occur after a metallic foreign body is left in the eye for a prolonged period of time
  • Issues occur when the rust ring is left as it can epithelialize and become a permanent spot in the patient’s vision
  • An eye burr or Alger brush can help to gouge out the rust ring in the emergency setting
  • These tools have a failsafe mechanism to prevent the eye burr from going through layers past the cornea (though this does not work if the foreign body is already through the cornea)
  • Referral to ophthalmology, antibiotic drops, and dilating drops are recommended options upon discharge
  • Complications include poor wound healing, scarring, and infection

References

Camodeca AJ, Anderson EP. Corneal Foreign Body. [Updated 2021 Apr 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536977/

https://www.reviewofoptometry.com/article/no-insult-to-injury-managing-foreign--body-removal

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

 

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