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Mental Health Monthly #17: Mania

Emergency Medical Minute

Release Date: 10/05/2023

Episode 893: Home Treatments for Button Battery Ingestion show art Episode 893: Home Treatments for Button Battery Ingestion

Emergency Medical Minute

Contributor: Aaron Lessen MD Educational Pearls: Button batteries cause alkaline corrosion and erosion of the esophagus when swallowed Children swallow button batteries, which create a medical emergency as they can perforate the esophagus A recent study compared various home remedies as first-aid therapy for button battery ingestion Honey, jam, normal saline, Coca-Cola, orange juice, milk, and yogurt The study used a porcine esophageal model to assess resistance to alkalinization with the different home remedies Honey and jam demonstrated a significantly lower esophageal tissue...

Episode 892: Tourniquets show art Episode 892: Tourniquets

Emergency Medical Minute

Contributor: Ricky Dhaliwal, MD Educational Pearls: What can you do to control bleeding in a penetrating wound? Apply direct pinpoint pressure on the wound as well as proximal to the wound. Build a compression dressing. How do you build a compression dressing? Think about building an upside-down pyramid with the gauze. Consider coagulation agents such as an absorbent gelatin sponge material, microporous polysaccharide hemispheres, oxidized cellulose, fibrin sealants, topical thrombin, or tranexamic acid. What are the indications to use a tourniquet? The Stop The Bleed campaign...

Pharmacy Phriday #11: Riddles, Medical Jargon, NNT, and Time Travel show art Pharmacy Phriday #11: Riddles, Medical Jargon, NNT, and Time Travel

Emergency Medical Minute

Contributors: Kali Olson PharmD, Travis Barlock MD, Jeffrey Olson MS2 Summary: In this episode of Pharmacy Phriday, Dr. Kali Olson joins Dr. Travis Barlock and Jeffrey Olson in studio to discuss a variety of interesting topics in the form of a segment show. Dr. Kali Olson earned her Doctorate of Pharmacy from the University of Colorado, Skaggs School of Pharmacy and completed a PGY1 residency at Detroit Receiving Hospital and a PGY2 residency in Emergency Medicine at Denver Health. She now works as an Emergency Medicine Pharmacist at Denver Health.  In segment one of the show, Kali and...

Episode 891: Hypothermia show art Episode 891: Hypothermia

Emergency Medical Minute

Contributor: Taylor Lynch MD Educational Pearls Hypothermia is defined as a core body temperature less than 35 degrees Celsius or less than 95 degrees Fahrenheit  Mild Hypothermia: 32-35 degrees Celsius Presentation: alert, shivering, tachycardic, and cold diuresis Management: Passive rewarming i.e. remove wet clothing and cover the patient with blankets or other insulation Moderate Hypothermia: 28-32 degrees Celsius Presentation: Drowsiness, lack of shivering, bradycardia, hypotension Management: Active external rewarming Severe Hypothermia: 24-28 degrees Celsius ...

Podcast 890: Outdoor Cold Air for Croup show art Podcast 890: Outdoor Cold Air for Croup

Emergency Medical Minute

Contributor: Jared Scott MD Educational Pearls: Croup is a respiratory condition typically caused by a viral infection (e.g., parainfluenza). The disease is characterized by inflammation of the larynx and trachea, which often leads to a distinctive barking cough. A common treatment for croup is the powerful steroid dexamethasone, but it can take up to 30 minutes to start working. A folk remedy for croup is to take the afflicted child outside in the cold to help them breathe better, but does it really work? A 2023 study in Switzerland, published in the Journal of Pediatrics,...

Podcast 889: Blood Pressure Cuff Size show art Podcast 889: Blood Pressure Cuff Size

Emergency Medical Minute

Contributor: Aaron Lessen MD Educational Pearls: Does the size of a blood pressure (BP) cuff matter? A recent randomized crossover trial revealed that, indeed, cuff size can affect blood pressure readings Design 195 adults with varying mid-upper arm circumferences were randomized to the order of BP cuff application: Appropriate Too small Too large Individuals had their mid-upper arm circumference measured to determine the appropriate cuff size Participants underwent 4 sets of triplicate blood pressure measurements, the last of which was always with the appropriately sized cuff ...

Podcast 888: Low GCS and Intubation show art Podcast 888: Low GCS and Intubation

Emergency Medical Minute

Contributor: Aaron Lessen MD Educational Pearls: Is the adage, “GCS of 8, you’ve got to intubate” accurate? A recent study published in the November 2023 issue of JAMA attempted to answer this question. Design Multicenter, randomized trial, in France from 2021 to 2023. 225 patients experiencing comatose in the setting of acute poisoning were randomly assigned to either a conservative airway strategy of withholding intubation or “routine practice” of much more frequent intubation. The primary outcome was a composite endpoint including in-hospital death, length of intensive care...

Podcast 887: Family Presence in Cardiac Resuscitation show art Podcast 887: Family Presence in Cardiac Resuscitation

Emergency Medical Minute

Contributor: Aaron Lessen MD Educational Pearls: A 2013 study randomized families of those in cardiac arrest into two groups: Actively offered patients’ families the opportunity to observe CPR Follow standard practice regarding family presence (control group) Of the 266 relatives that received offers to observe CPR, 211 (79%) accepted vs. 43% in the control group observed CPR The study assessed a primary end-point of PTSD-related symptoms 90 days after the event Secondary end-points included depression, anxiety, medicolegal claims, medical efforts at resuscitation, and the...

Podcast 886: Cough in Kids show art Podcast 886: Cough in Kids

Emergency Medical Minute

Contributor: Ricky Dhaliwal, MD Educational Pearls: Croup Caused by: Parainfluenza, Adenovirus, RSV, Enterovirus (big right now) Age range: 6 months to 3 years Symptoms: Barky cough Inspiratory stridor (Severe = stidor at rest) Use the Westley Croup Score to gauge the severity Treatment: High flow, humidified, cool oxygen Dexamethasone 0.6 mg/kg oral, max 16mg Severe: Racemic Epinephrine 0.5 mL/kg Consider heliox, a mixture of helium and oxygen Very severe: be ready to intubate Bronchiolitis Caused by: RSV, Rhinovirus Symptoms are driven by...

Podcast 885: Penetrating Neck Injuries show art Podcast 885: Penetrating Neck Injuries

Emergency Medical Minute

Contributor: Ricky Dhaliwal MD Educational Pearls: Three zones of the neck with different structures and risks for injuries: Zone 1 is the most caudal region from the clavicle to the cricoid cartilage Zone 2 is from the cricoid cartilage to the angle of the mandible Zone 3 is superior to the angle of the mandible Zone 1 contains the thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins), carotid arteries, vertebral artery, apices of the lungs, trachea, esophagus, spinal cord, thoracic duct, thyroid gland, jugular veins, and the vagus nerve.  Zone...

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Andrew White MD - Outpatient Psychiatrist; Fellowship Trained in Addiction Psychiatry; Denver Health

Travis Barlock MD - Emergency Medicine Physician; Swedish Medical Center


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

  • Initial assessment of suspected mania can be done via DIGFAST:

    • Distractibility - Individual that is unable to carry a linear, goal-directed conversation

    • Impulsivity - Executive functioning is impaired and patients are unable to control their behaviors

    • Grandiosity - Elevated mood and sense of self to delusions of grandeur

    • Flight of ideas - Usually described as racing thoughts

    • Agitation - Increase in psychomotor activity; start several projects of which they have little previous knowledge 

    • Sleep decrease - Typically, manic episodes start with insomnia and can devolve into multiday sleeplessness

    • Talkativeness - More talkative than usual with pressured speech and a tangential thought process

  • Interviewing patients requires an understanding of mood-based mania vs. psychosis-based mania

    • An individual with mood-based mania will more likely be restless, whereas a patient with psychosis-based mania will be more relaxed from a psychomotor standpoint

  • Treatment of manic patients in the ED includes the use of antipsychotics to manage acute symptomatology

    • Management can be informed and directed by the patient’s history i.e. known medications that have worked for the patient

  • ED management of manic patients involves a work-up for a broad differential including agitated delirium, substance-induced mania, metabolic disorders, and autoimmune diseases.

  • Some individuals experience manic episodes from marijuana and other illicit substances

  • Antidepressants used in bipolar patients for suspected depression may induce mania

    • Important to avoid using antidepressants as first-line therapy

  • Mental health holds can be beneficial in patients with grave disabilities from mania

    • Oftentimes, undertreatment of manic episodes leads to re-hospitalization

  • Inpatient treatment:

    • Environment is important - ensure that patients get solo rooms if possible to minimize stimulation

    • Antipsychotics, including risperidone and olanzapine, with or without a benzodiazepine, are useful for short-term agitation

    • Long-term treatment involves coupled pharmacological treatments with non-pharmacological treatments

  • Sleep

    • Fractured sleep is one of the earliest warning signs that someone has an imminent manic episode

    • Poor sleep can be an inciting factor for mania, which then turns into a cycle that further propagates a patient’s manic episode

Summarized and edited by Jorge Chalit, OMSII | Studio production by Jeffrey Olson, MS2