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Podcast 756: Violence Towards ED Staff

Emergency Medical Minute

Release Date: 02/15/2022

Episode 870: Advanced Trauma Life Support (ATLS) show art 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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Emergency Medical Minute

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Emergency Medical Minute

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Episode 867: Occult Scaphoid Fractures show art 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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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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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 show art 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) show art 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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Emergency Medical Minute

Contributor: Aaron Lessen MD Educational Pearls: Patients with alcohol use disorder are frequently discharged from the ED without further resources Pharmacological treatments to reduce cravings in AUD exist Naltrexone  Effective at reducing alcohol cravings and heavy drinking  Gabapentin Reduces the percentage of heavy drinking days in AUD Patients being discharged from the ED should be asked if they feel their alcohol use is a problem, which can further direct appropriate pharmacological interventions References 1. Kranzler M.D. HR, Feinn Ph.D. R, Morris B.A. P,...

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Podcast 862: How to Apply a Painful Stimulus show art Podcast 862: How to Apply a Painful Stimulus

Emergency Medical Minute

Contributor: Travis Barlock MD Educational Pearls: When might you need to apply a painful stimulus in a medical setting? The main reason is to assess the patient's level of consciousness, such as when they are waking up from anesthesia or have potentially suffered a brain injury. It can be part of the Glasgow Coma Scale (GCS) if patients are not responding to auditory stimuli. Possible levels of consciousness include Alert, Lethargic, Obtunded, and Comatose (ALOC) What are the approved ways to apply a painful stimulus to assess central nervous system function? Trapezius squeeze. Grab...

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Contributor: Jared Scott, MD

Educational Pearls:

  • ACEP survey was done in 2018 looking at violence towards staff in the ED with only 10% of those solicited responding
  • Survey found 47% of respondents were assaulted and 71% had witnessed violence towards staff
  • Regarding what was done about the violence, 28% said patients were flagged by the hospital, 21% said patient was arrested by police/hospital security, 6% of the cases resulted in the hospital pressing charges, and in 3% of cases the staff were advised to press charges
  • Analyzing the type of violence that occurred, it was found that in 44% of the incidents staff were hit/slapped, 30% were spit on, 28% were punched, 27% were kicked, 17% were scratched, 6% were bitten, 2% were assaulted with a weapon, and 1% were sexually assaulted
  • ED violence is a very serious matter and you can learn more about the survey and initiatives at the links below

References

https://www.acep.org/administration/violence-in-the-emergency-department-resources-for-a-safer-workplace/

https://www.emergencyphysicians.org/press-releases/2018/10-2-2018-violence-in-emergency-departments-is--increasing-harming-patients-new-research-finds

https://stopedviolence.org/

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

 

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