Podcast 846: Early Repolarization vs. Anterior STEMI
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: Early repolarization a benign EKG pattern that can mimic an anterior STEMI Can be seen in the anterior leads typically in young male patients Can differentiate Early Repolarization vs Anterior STEMI by looking at four variables: Corrected QT interval QRS amplitude in V2 R wave amplitude in V4 ST elevation 60 ms after J point in V3 These four variables can be plugged into a formula (available on MDCalc) Note that a longer QT is more corelated with STEMI References Macfarlane PW, Antzelevitch C, Haissaguerre M, et al. The Early...
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Podcast 845: Hyperkalemic Cardiac Arrest
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia may cause cardiac arrest Treatment of suspected hyperkalemic cardiac arrest begins with typical management of cardiac arrest including high-quality CPR, defibrillation if appropriate, and resuscitation medications Administer calcium products to stabilize cardiac membrane and potassium shifting medications If ROSC is achieved, initiate dialysis There are several case reports of patients being dialyzed while CPR is ongoing, with some success Dialysis during resuscitation may be an appropriate...
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Podcast 844: Dental Infections
Emergency Medical Minute
Contributor: Meghan Hurley, MD Educational Pearls: Educational Pearls: Dental infections can be categorized into two main groups Infections of the gums Pericoronitis Tooth eruption leading to inflammation/irritation Can progress to an infection Requires pain control, no antibiotics Gingivitis Inflammation of the gums Can lead to an infection requiring antibiotics Abscess (gums) If an infection develops in the gums it can progress to an abscess May require drainage Acute necrotizing ulcerative gingivitis (ANUG) aka Trench Mouth Filmy, grayish discoloration of the gums with “punched...
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Podcast 843: Commotio Cordis
Emergency Medical Minute
Contributor: Jared Scott, MD Educational Pearls: Commotio cordis is sudden ventricular fibrillation precipitated by direct impact to the chest A national registry, US Commotio Cordis Registry, reports an average of 10-20 cases annually 95% of reported cases occur in males, indicating possible genetic component Average age of patient in registry is 15 Most cases occur during sporting events (baseball in particular), in addition to physical altercations and industrial accidents Treatment is high quality CPR and early defibrillation Survival rate is...
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Podcast 842: “History of Wound Care”
Emergency Medical Minute
Contributor: Chris Holmes, MD Educational Pearls: Through world history, there have been various interesting approaches to wound care Ancient Egyptians applied honey, lint, and grease which provided antimicrobial, absorptive and moisturizing properties, respectively Ancient Greeks irrigated wounds with clean water and applied wine and vinegar which may have been antimicrobial One of the first synthetic topical antimicrobials was a dye researched by scientist and later produced by Bayer under the name Prontosil Some current wound care methods include wet-to-dry dressings,...
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Podcast 841: Wound Care
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Wound care in the emergency department aims to prevent future infection Copious wound irrigation is the important step in preventing wound infection Studies have shown that irrigation with tap water is just as effective, if not superior, to irrigation with saline or other solutions Several studies have shown no reduction in wound infection rates when using sterile gloves during wound care Recent study in the Netherlands compared infection rates between patients undergoing wound repair with and without sterile gloves Receiving...
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Podcast 840: Abnormal Pediatric Vitals at Discharge
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Pediatric patients frequently have vital signs considered abnormal for age at discharge Large multicenter study recently evaluated if pediatric patients discharged with abnormal vital signs have worse outcomes 97,824 pediatric discharges were included in the study 18.1% were discharged with vitals considered abnormal for age No significant difference in readmission rates at 48 hours (2.28% in abnormal cohort vs. 2.45% in normal cohort) No significant adverse outcomes in those discharged with abnormal vital signs (4 total PICU admissions...
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Podcast 839: Causes of Pancreatitis
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: The causes of pancreatitis can be remembered with the mnemonic: “GET SMASHED” G: Gallstones (Most common cause of pancreatitis overall) E: Ethanol (Alcohol consumption is the most common cause of chronic pancreatitis) T: Trauma S: Steroids M: Malignancy A: Autoimmune S: Scorpion Sting H: Hypertryglyceridemia E: ERCP D: Drugs (e.g. Valproate, Antiretrovirals) References Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic pancreatitis. Lancet. 2020;396(10249):499-512....
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Podcast 838: Sternoclavicular Septic Arthritis
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Septic arthritis of the sternoclavicular joint is uncommon accounting for <1% of septic arthritis cases Immunosuppression and IV drug use increases the risk Can account for up to 17% of septic arthritis cases in patients who use IV drugs Symptoms are typically vague with pain presenting around where the sternum meets the clavicle Consider imaging with CT or MRI and draining/analyzing the fluid if possible Antibiotics are the mainstay of treatment, but surgery may be required to wash out joint and resect infected bone As septic...
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Podcast 837: Snakebites
Emergency Medical Minute
Contributor: Meghan Hurley, MD Educational Pearls: Venomous snakes in the United States include species from the family Elapidae and subfamily Crotalinae In prehospital setting, elevate the bitten extremity and transport to hospital immediately Do not attempt interventions with the bite site Monitor for progression of swelling past any joint line, systemic symptoms or lab abnormalities for 8-12 hours Symptoms may present up to hours after bite Crotalinae venom has heme toxicity and may present with lab pattern of DIC Treatment for all symptoms is antivenom ...
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- Most common sexually transmitted disease (STD) in North America: Human Papillomavirus (HPV)
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- From the emergency department patients should be connected to follow-up care and educated on vaccine series
- Most common non-viral STD in North America: Trichomonas Vaginalis
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- While men may be asymptomatic, they can transmit the disease to women who may experience irritation leading to increased likelihood of PID and contraction of other STDs and HIV
- Trichomonas is diagnosed via wet preparation with visualization of motile parasites
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- Similarly, men’s urine can be tested for visualized motile parasites
- Expedite lab as parasites are motile for about one hour
- PCR test is becoming more available
- Most common bacterial STD in North America: Chlamydia trachomatis
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- Neisseria gonorrhoeae is a less common bacterial STD but does have high rates of drug resistance
- Empiric STD treatment includes IM Ceftriaxone and PO Doxycycline
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- Providers should consider adding Flagyl for Trichomonas Vaginalis coverage
References
Sexually transmitted disease surveillance, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/2020/default.htm. Published August 22, 2022. Accessed November 21, 2022.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. Published 2021 Jul 23. doi:10.15585/mmwr.rr7004a1
Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD
In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/