Carepoint Journal Club: Occlusion Myocardial Infarction
Emergency Medical Minute
Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.
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Podcast 1004: Sinus Arrest Post TAVR
Emergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: Conduction abnormalities are a common and clinically significant complication in patients who undergo transcatheter aortic valve replacement (TAVR) Clinical Features The most common abnormalities include high grade AV block and new onset LBBB Due to the close proximity of the aortic annulus to the AV node and His-Purkinje system More common in males, the elderly, and those with pre-existing conduction disease (RBBB or LBBB) Sinus pauses and sinus arrest are a rare post-TAVR rhythm disturbances Temporary...
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Podcast 1003: Nasal Intubation
Emergency Medical Minute
Contributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point for the ETT (nare v.s. mouth). Nasal Intubations are seldom preferred to oral intubations as they carry risk for inducing bleeding from trauma to the nasal passages. Indications for nasal intubations include: Anatomical abnormalities that may make...
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Podcast 1002: Elder Agitation
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder. What environmental changes can help reduce agitation? Maintain a quiet, calm, uncluttered environment Dim the lights Ensure the patient has their glasses,...
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Podcast 1001: Acute Intermediate Risk Pulmonary Embolism
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized...
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Celebrating 1000 Medical Minutes
Emergency Medical Minute
Hosts: Don Stader, Nate Novotny, Travis Barlock, and Jeffrey Olson In this episode, we reminice about the first 1000 medical minutes presented by EMM and what the next 1000 might hold. Below are all of the episodes referenced in this episode. Please go back and give them all a listen. Segment 1- Recap and Facts 1st medical minute o April 29, 2016. Almost exactly 10 years ago. o Diverticulitis and Antibiotics by Dr. Chris Holmes 1000th Medical Minute o March 30, 2026 o Treatment of burns by Aaron Lessen o Edited by Ashley Lyons and published by Jorge Chalit...
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Podcast 1000: Cool Water
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Burns range in complexity from minor first-degree burns to more severe full-thickness burns. Initial basic burn management: Run the burn under cool running water for 20 minutes. Do not scrub the skin. Do not use ice water. Ideally initiated as soon as possible, but no later than 3 hours after injury. Applicable to all burns ranging from superficial to full thickness. Then apply a non-adherent dressing or sterile gauze. Can be done at home or upon presentation to the emergency department. These steps decrease pain and minimize tissue damage....
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Podcast 999: Right vs Left Internal Jugular Access
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: What is an internal jugular catheter (IJ) and when do we use it? IJs are catheters that can be placed in either the left or the right internal jugular vein to provide central venous catheter (CVC) access. CVCs can be placed in other locations other than the internal jugular vein (i.e. subclavian vein or femoral veins). IJs are used when the patient may require long-term venous access or have to receive hyperosmolar solutions (such as solutions with high glucose content for parenteral nutrition); solutions with extreme pHs (<5 or >9);...
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Podcast 998: Delayed Intubation After an Overdose
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: How long do we need to watch patients with a presumed overdose who were treated with naloxone in the field? A 2025 study in the Annals of Emergency Medicine took a look at this question Methods Prospective, multi-institutional cohort study Included ED patients with suspected acute opioid overdose with biologic testing to confirm substances. This paper performed a secondary analysis evaluating the risk of “delayed intubation,” defined as intubation occurring >4 hours after ED arrival. Results 1,591 patients with presumed opioid...
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Podcast 997: D-Dimer
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: D-dimer: fibrin degradation product used to evaluate for clot formation and breakdown Threshold: <500ng/mL rules out venous thromboembolism in low risk patients Elevated D-dimer indicates recent or ongoing intravascular coagulation and fibrinolysis YEARS score: algorithm to assess PE risk using three clinical criteria Criteria: signs of DVT, hemoptysis, and PE as the most likely diagnosis YEARS score of 0 with D-dimer <1000 ng/mL: PE can be ruled out YEARS score of ≥1 with D-dimer <500 ng/mL: PE can be ruled out A study found...
info_outlineContributor: 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 out” lesions
- Extremely painful
- Can cause teeth to loosen and fall out
- Treat with IV antibiotics + admission
- Infections of the teeth
- Dental caries
- Causes sensitivity tooth enamel is worn through
- Can lead to infection
- Periapical abscess
- Abscess that extends through the root of the tooth
- Can develop up elsewhere in tooth/gums/mouth
- Causes tooth sensitivity when tapped
- Ludwig angina
- Infection of the soft tissue under the tongue
- Can compromise airway as it expands
- Treat with extensive antibiotics and debridement
- Antibiotic stewardship
- Commonly used antibiotics for dental infections
- Clindamycin
- Augmentin
- Amoxicillin
- Chlorhexidine (Peridex)
- Antiseptic and disinfectant that is helpful for gingival irritation
References
Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig's angina: An evidence-based review. Am J Emerg Med. Mar 2021;41:1-5. doi:10.1016/j.ajem.2020.12.030
Dufty J, Gkranias N, Donos N. Necrotising Ulcerative Gingivitis: A Literature Review. Oral Health Prev Dent. 2017;15(4):321-327. doi:10.3290/j.ohpd.a38766
Herrera D, Roldán S, Sanz M. The periodontal abscess: a review. J Clin Periodontol. Jun 2000;27(6):377-86. doi:10.1034/j.1600-051x.2000.027006377.x
Kumar S. Evidence-Based Update on Diagnosis and Management of Gingivitis and Periodontitis. Dent Clin North Am. Jan 2019;63(1):69-81. doi:10.1016/j.cden.2018.08.005
Kwon G, Serra M. Pericoronitis. StatPearls. StatPearls Publishing
Copyright © 2022, StatPearls Publishing LLC.; 2022.
Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD
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