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Podcast 776: Single-Site Blood Cultures

Emergency Medical Minute

Release Date: 04/26/2022

Podcast 795: Lithium Toxicity show art Podcast 795: Lithium Toxicity

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Lithium remains a commonly used medication for treating bipolar disorder Lithium toxicity can be acute, acute-on-chronic, or chronic  Measuring blood lithium level Therapeutic range of lithium is around 1.6-1.8 mEq/L >2 mEq/L is likely to cause significant toxicity >4 mEq/L necessitates lifesaving treatment The lethal dose of lithium is 700 mg/kg Lithium can have delayed absorption resulting in levels increasing during hospitalization Symptoms associated with acute lithium toxicity Gastrointestinal Nausea, vomiting, abdominal...

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Podcast 794: Brain and Pain show art Podcast 794: Brain and Pain

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Pain sensation is generated and modified by the brain Multiple case reports provide evidence that the degree of pain a patient experiences correlates with how severe they perceive their injury/illness to be        Patients who feel safe and reassured about the care they are receiving have less pain     The patient’s narrative about their pain is the strongest factor in determining long-term outcomes of their pain Helping to shape the narrative around the patient’s pain is essential in...

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Podcast 793: Postintubation Sedation and Analgesia show art Podcast 793: Postintubation Sedation and Analgesia

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for patients with intracranial bleeds Precedex is a milder sedative used in the ICU because it decreases time to extubation and reduces the risk of complications associated with long term intubation  Ketamine...

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Podcast 792: Rectal Prolapse show art Podcast 792: Rectal Prolapse

Emergency Medical Minute

Contributor: Jarod Scott, MD Educational Pearls: Rectal prolapse is an evagination of the rectal tissue through the anal opening Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities Noninvasive treatment options include increasing fluid and fiber intake to soften stools as well as using padding/taping to reinforce the perineum Surgery is an option to repair the prolapse so long as the patient is a...

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Podcast 791: Hyperglycemic Hyperosmolar State show art Podcast 791: Hyperglycemic Hyperosmolar State

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality Unlike in DKA, patients with HHS do not have elevated ketones Treatment of HHS includes insulin administration along with correcting fluid and electrolyte abnormalities When treating HHS, it is important to monitor and follow osmolality...

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On the Streets #14: Trauma Activations in the Field show art On the Streets #14: Trauma Activations in the Field

Emergency Medical Minute

The Emergency Medical Minute is excited to announce that we our upcoming event, Palliative. Check out our event page for more information and to buy tickets: Palliative Eventbrite Page

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Podcast 790: Opioids vs OTC Pain Meds show art Podcast 790: Opioids vs OTC Pain Meds

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: NSAIDs are a potential alternative to opioids for pain management and are associated with decreased rates of adverse effects A recent study evaluated the effectiveness of ibuprofen and oxycodone for pain management in pediatric patients with isolated, acute-limb fractures Participants were discharged home with either ibuprofen or oxycodone and followed for six weeks  There was no difference in pain scores between those taking ibuprofen and those taking oxycodone indicating that they had comparable analgesic effects Those in the ibuprofen...

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Podcast 789: DOAC show art Podcast 789: DOAC

Emergency Medical Minute

Contributor: Aaron Lessen, MD  Educational Pearls: Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis.  Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes.  2 large observational studies evaluated the recurrence of clots and bleeding risk in patients with newly prescribed Eliquis® or Xarelto® for DVT or PE. Both studies found...

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Mental Health Monthly #13: Substance-Induced Psychosis (Part I) show art Mental Health Monthly #13: Substance-Induced Psychosis (Part I)

Emergency Medical Minute

Substance-Induced Psychosis (Part I)   In this first episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the different substances that cause psychosis and their unique presentations in the ED and in the psychiatric world. First, Dr. Haddad establishes a medical definition of psychosis. Then, Dr. Haddad and Dr. Dhaliwal partake in a fruitful discussion, each providing their unique perspective on the drugs that affect our patient populations today.   Key Points:   ...

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Podcast 788: Tracheostomy Bleeding show art Podcast 788: Tracheostomy Bleeding

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Tracheostomy bleeding is a rare but potentially life-threatening complication that usually occurs within the first month of tracheostomy tube placement No matter how severe the bleeding, every patient should be evaluated to rule out a tracheo-innominate fistula between the tracheostomy and the innominate artery If the patient is currently bleeding and has a cuffed tracheostomy tube, over-inflate the balloon to compress the bleeding vessel Consider replacing an uncuffed tracheostomy tube with a cuffed tube or an ET tube If the tracheostomy was...

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More Episodes

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 Retrospective Clinical Study. J Clin Microbiol. 2022;60(2):e0193521. doi:10.1128/JCM.01935-21

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

 

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