Podcast 879: A Case of Pediatric Anaphylactic Shock
Emergency Medical Minute
Contributor: Dr. Taylor Lynch Educational Pearls: Time of arrival until intubation was 26 minutes but nobody tried anterior neck access like a cricothyrotomy until his dad arrived Traditional ACLS protocol is not enough for anaphylactic respiratory arrest Circulating O2 from compressions alone is not enough to sustain the brain Patients need a definitive airway and endotracheal tube is the best method BVM ventilation is not enough to get patients the oxygen they need Time to anoxic brain injury during a respiratory arrest is 4 minutes Definition of anaphylactic shock: Acute...
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Podcast 878: Opioids for Low Back and Neck Pain
Emergency Medical Minute
Contributor: Jared Scott MD Educational Pearls: Should we use opioids to treat low back and neck pain? The OPAL Trial, published in The Lancet, in June 2023, attempted to answer this very question. Objective: Investigate the efficacy and safety of a short course of opioid analgesic (oxycodone-naloxone) for acute low back pain and neck pain. Trial Design: Triple-blinded, placebo-controlled randomized trial, conducted in Emergency and Primary Care in Sydney, Australia, involving adults with 12 weeks or less of low back or neck pain. Participants: 347 recruited adults (174 in the opioid...
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Podcast 877: Viral Respiratory Infections in Children
Emergency Medical Minute
Contributor: Jared Scott MD Educational Pearls A recently published study assessed the burden of respiratory viruses in a longitudinal cohort of children from 0 to 2 years of age The children in the study received nasal swab PCR testing weekly to determine infectivity They were also monitored for symptoms via weekly text surveys The study differentiated between infection and illness by defining an acute respiratory illness (ARI) as fever ≥38°C or cough. The median infectivity rate was 9.4 viral infections per child per year The median illness rate was 3.3 ARIs per child...
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Podcast 876: Sedation Pearls
Emergency Medical Minute
Contributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA receptors. Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP). Downsides: Hypotension, bradycardia, respiratory depression. What should you do if a patient is getting hypotensive on propofol? Do not stop the...
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Podcast 875: A Pediatric Case of Myopericarditis
Emergency Medical Minute
Contributor: Meghan Hurley MD Educational Pearls: Pericarditis is inflammation of the pericardial sac, which can arise from infectious or non-infectious etiologies Myocarditis is inflammation of the myocardium, which may accompany pericarditis Pericarditis clinical findings include: Diffuse concave ST elevation, classic for acute pericarditis with myocardial involvement. More common in younger male patients Elevated high-sensitivity troponin - higher levels may occur in young healthy patients Ultrasound may show pericardial effusions POCUS may be helpful in assessing left...
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Episode 874: Bradyarrhythmias
Emergency Medical Minute
Contributor: Dylan Luyten MD Educational Pearls: What is a Bradyarrhythmia? Also known as a bradyarrhythmia, it is an irregular heart rate that is also slow (below 60 beats per minute). What can cause it? Complete heart block AKA third-degree AV block; identified on ECG by a wide QRS, and complete dissociation between the atrial and ventricular rhythms with the ventricular being much slower. Treat with a pacemaker. Medication overdose, especially beta blockers. Many other drugs can slow the heart as well including: opioids, clonidine, digitalis, amiodarone, diltiazem, and verapamil to...
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Podcast 873: Intravesical Tranexamic Acid for Gross Hematuria
Emergency Medical Minute
Contributor: Aaron Lessen MD Educational Pearls: Tranexamic acid (TXA) is a common medication to achieve hemostasis in a variety of conditions Patients visiting the ED for gross hematuria (between March 2022 and September 2022) were treated with intravesical TXA 1 g tranexamic acid in 100 mL NS via Foley catheter Clamped Foley for 15 minutes Subsequent continuous bladder irrigation, as is standard in most EDs Compared with a cohort of patients visiting the ED for a similar concern between March 2021 and September 2021, the TXA patients had: A shorter median length of stay in...
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Podcast 872: Preseptal and Orbital Cellulitis
Emergency Medical Minute
Contributor: Meghan Hurley MD Educational Pearls: What is Cellulitis? A common and potentially serious bacterial skin infection. Caused by various types of bacteria, with Streptococcus and Staphylococcus species being the most common. What is Preseptal Cellulitis and why is it more serious than facial cellulitis? Preseptal Cellulitis, also known as Periorbital Cellulitis, is a bacterial infection of the soft tissues in the eyelid and the surrounding area. This requires prompt and aggressive treatment to avoid progression into Orbital Cellulitis. How is Preseptal Cellulitis treated?...
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Mental Health Monthly #17: Mania
Emergency Medical Minute
Contributors: Andrew White MD - Outpatient Psychiatrist; Fellowship Trained in Addiction Psychiatry; Denver Health Travis Barlock MD - Emergency Medicine Physician; Swedish Medical Center Summary In this episode of Mental Health Monthly, Dr. Travis Barlock hosts Dr. Andrew White to discuss the elements of mania that may be encountered in the emergency department. The discussion includes a helpful mnemonic to assess mania, work-up and treatment in the ED, underlying causes of mania, mental health holds, inpatient treatment, and the role of sleep in mania. Educational Pearls ...
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Podcast 871: Increased Intracranial Pressure and the Cushing Reflex
Emergency Medical Minute
Contributor: Travis Barlock MD Education Pearls: The Cushing Reflex is a physiologic response to elevated intracranial pressure (ICP) Cushing’s Triad: widened pulse pressure (systolic hypertension), bradycardia, and irregular respirations Increased ICP results from systolic hypertension, which causes a parasympathetic reflex to drop heart rate, leading to Cushing’s Triad. The Cushing Reflex is a sign of herniation Treatment includes: Hypertonic saline is comparable to mannitol and preferable in patients with hypovolemia or hyponatremia Give 250-500mL of 3%NaCl ...
info_outlineContributor: Meghan Hurley MD
Educational Pearls:
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Shift work is defined as anything that takes place outside of a 9-5 schedule, not exempting day-shift medical workers
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Various ill effects of shift work on overall health:
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Increased all-cause mortality
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Increased number of accidents
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Glucose metabolism dysregulation
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Increased BMI
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Fertility impacts for men and women
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Increased breast cancer risk
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Decreased cognitive functioning
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Mitigation strategies
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Work at the same time every day
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Anchor Sleep - always try to be asleep at the same time of day
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Progressive shifts: day- into swing- into night shift instead of the other way around
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Three days off after a stretch of nights can help reset sleep schedule
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Shorter night shifts
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Morning shifts should start no earlier than 8 AM
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Sleep hygiene
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Ensure an ideal sleep environment; cool, dark, and damp
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Avoid bright lights when going to sleep
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Exposure to bright lights when waking up
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Hydration throughout your shift
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Stop caffeine at midnight if you are working a night shift
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Eat healthy meals and avoid junk food
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Avoid eating 2-3 hours before going to sleep
References
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Boivin, D. B., Boudreau, P., & Kosmadopoulos, A. (2022). Disturbance of the Circadian System in Shift Work and Its Health Impact. Journal of biological rhythms, 37(1), 3–28. https://doi.org/10.1177/07487304211064218
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Jang TW. Work-Fitness Evaluation for Shift Work Disorder. Int J Environ Res Public Health. 2021;18(3):1294. Published 2021 Feb 1. doi:10.3390/ijerph18031294
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Minors DS, Waterhouse JM. Anchor sleep as a synchronizer of rhythms on abnormal routines. Int J Chronobiol. 1981;7(3):165-188.
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Reinganum MI, Thomas J. Shift Work Hazards. [Updated 2023 Jan 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589670/
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII