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Podcast 787: TAVR and Stroke

Emergency Medical Minute

Release Date: 06/06/2022

Podcast 804: Brugada Criteria for V Tach show art Podcast 804: Brugada Criteria for V Tach

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Tachycardia describes a heart rate of >120 beats per minute Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG The major differential for a wide complex tachycardia is Ventricular Tachycardia (VT), aka “V Tach”, or Supraventricular Tachycardia (SVT) with Aberrancy   SVT alone is a narrow complex tachycardia, but as rate increases a right or left bundle branch block pattern may emerge, creating SVT with Aberrancy seen as a wide complex on EKG It is important to distinguish the rhythms as...

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Podcast 803:  Sedation During Intubation show art Podcast 803:  Sedation During Intubation

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications  Patients who suffer from this effect are at high risk of developing severe PTSD, depression, and suicidal ideations Occurs in approximately 0.1-0.2% of patients undergoing general anesthesia in an OR setting 2021 study showed patients intubated in the ED have a much higher rate of experiencing awareness during intubation 2.6% chance of awareness in patients undergoing intubation and mechanical ventilation in the ED Higher...

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Pediatric Palliative Care Expert Panel show art Pediatric Palliative Care Expert Panel

Emergency Medical Minute

Selected audio from our event, Palliative, hosted on June 27, 2022 in conjunction with Children's Hospital Colorado's Department of Palliative Medicine and . Keynote address by Dr. Nadia Tremonti, pediatric palliative care physician at Children's Hospital of Michigan Expert Panel composed of Dr. Kimberly Bennett, medical director for TDH's Footprints Program, Dora Mueller, clinical nurse coordinator for palliative care at Children's and Cassie Matz, LCSW bereavement coordinator at Children's. The evening commenced following a screening of the 2019 award-winning documentary, Palliative,...

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Podcast 802: Intranasal Medication Administration for Pediatric Patients show art Podcast 802: Intranasal Medication Administration for Pediatric Patients

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Intranasal medication administration is a convenient, quick, and relatively painless option for pediatric patients Often used as an initial medication to help control pain in children prior to establishing an IV Using an atomizer is preferred when administering intranasal medications The syringe should be angled towards the ipsilateral eye or occiput rather than straight upwards Do not administer more than 1 mL of fluid per nostril as volumes greater than 1 mL are not sufficiently absorbed Intranasal medication doses differ from the...

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Mental Health Monthly #14: Substance-Induced Psychosis (Part II) show art Mental Health Monthly #14: Substance-Induced Psychosis (Part II)

Emergency Medical Minute

In this second 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 various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from mentally ill patients.    Key Points:   Pharmacologic treatments for...

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Podcast 801: Push Dose Vasopressors show art Podcast 801: Push Dose Vasopressors

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: There are two common options for push-dose vasopressor: phenylephrine and epinephrine. Both have been studied in the setting of the OR, but are lacking data in emergency room utilization.  A recent retrospective study at one hospital compared the two options for effectiveness and safety. The data showed phenylephrine raised systolic pressure an average 26 points while epinephrine raised the systolic pressure higher, an average of 33 points. Additionally, the same study showed dosing errors were more common in epinephrine. The error rates...

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Podcast 800: Mortality in Fevers show art Podcast 800: Mortality in Fevers

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: A recent study evaluated the association between the degree of fever and mortality rate in patients presenting to a set of Emergency Departments in Israel Febrile patients with a temperature > 38.0 C were recorded and these patients were compared against local death records to determine the all-cause 30-day mortality rate 8.1% of patients evaluated in the ED were determined to be febrile 30-day mortality for all febrile patients was around 12%  Patients with fever >40 C have a mortality rate approaching 24% Patients febrile to...

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Podcast 799: EKG Abnormalities in Renal Failure show art Podcast 799: EKG Abnormalities in Renal Failure

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Patients in renal failure may have elevated serum potassium levels which can result in EKG changes.   EKG changes in the setting of hyperkalemia generally depend on the serum level. Mild elevation may cause peaked T waves. At higher serum levels there will be loss of P waves plus wide complex tachycardia. There can be progression to fatal arrhythmias.   Treatment of acute hyperkalemia involves multiple mechanisms. Calcium gluconate stabilizes the cardiac membrane (of note, its duration of action is 1 hour). Insulin with...

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Podcast 798: Digit Reimplantation show art Podcast 798: Digit Reimplantation

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Multiple factors affect if a digit can be reattached including: location of digit injury, mechanism of injury, duration since injury, preservation mechanism.  Recommended preservation is via indirect cooling. This is accomplished by wrapping the amputated digit piece in saline soaked gauze, placing the wrapped piece in a waterproof bag and putting the bag in ice water for transport. Avoid direct contact of the digit with ice.  A single center study showed that only 34% of the total digits received were properly preserved. Lower rates...

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Podcast 797: Vitamin C in Sepsis show art Podcast 797: Vitamin C in Sepsis

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Prior, smaller studies showed intravenous Vitamin C given to patients with sepsis significantly improved patient mortality and additional outcomes.  A recently published, randomized control trial with >800 ICU patients who received up to 4 days of IV Vit C or placebo concluded that the end points of death or persistent organ dysfunction at 28 days were unaffected by Vitamin C administration. There were no adverse safety outcomes associated with Vitamin C administration.   Based on this trial, it is unlikely that Vitamin C...

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More Episodes

Contributor: Nick Hatch, MD

Educational Pearls:

  • Transcatheter aortic valve replacement (TAVR) is an increasingly common endovascular procedure to treat aortic stenosis
  • TAVR is an alternative to the open approach surgical aortic valve replacement (SAVR) for patients who are inoperable or are high risk surgical candidates
  • Following TAVR, there is increased risk of stroke, particularly in the first 30 days
  • TAVR-related strokes are due to embolic debris left on the valve root, which is generally cleaned out during SAVR
  • Further, following the procedure many patients are anticoagulated which increases the risk for conversion to hemorrhagic stroke
  • Isolated, unexplained nausea and vomiting in elderly patients should prompt concern for a neurologic workup with imaging - even more so if they have recently undergone TAVR 

References

Davlouros PA, Mplani VC, Koniari I, Tsigkas G, Hahalis G. Transcatheter aortic valve replacement and stroke: a comprehensive review. J Geriatr Cardiol. 2018;15(1):95-104. doi:10.11909/j.issn.1671-5411.2018.01.008

Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement in High-Risk Patients. J Am Coll Cardiol. 2018;72(22):2687-2696. doi:10.1016/j.jacc.2018.08.2146

Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J. 2019;40(38):3143-3153. doi:10.1093/eurheartj/ehz275

Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD

 

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