Emergency Medical Minute
Contributor: Megan Hurley, MD Educational Pearls: Fevers Tylenol Up until 20 weeks NSAIDs are ok but after 20 weeks they are contraindicated Can limit the amount of amniotic fluid produced Can lead to growth restriction Can cause premature closure of the ductus arteriosus Cough Cough drops Humidifier Guafenesine and dextromethorphan (Mucinex) is not well studied but is probably ok with caution in certain circumstances such as post-tussive emesis causing poor PO intake and weight loss Congestion Flonase (Fluticasone nasal spray) Nasal rinses Humidifier 1st...
info_outline Episode 923: Blunt Cerebrovascular InjuryEmergency Medical Minute
Contributor: Travis Barlock MD Educational Pearls: Assessment of head and neck vascular injury due to blunt trauma Symptomatic patients require screening head and neck CT angiography EAST guidelines include the following criteria for a screening CT angiography in blunt head trauma: Unexplained neurological deficits Arterial nosebleed GCS < 6 Petrous bone fracture Cervical spine fracture Any size fracture through the transverse foramen LeFort fractures type II or type III EAST guidelines include a grading scale for vascular injury: Grade I: Luminal irregularity...
info_outline Episode 922: Chest Tube IrrigationEmergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Hemothorax: blood in the pleural cavity, most commonly due to chest trauma Treatment: thoracostomy tube for blood drainage helps to avoid clotting, scarring, and infection A recent study looked at patients with hemothorax who either received or did not receive thoracic irrigation with saline Evaluated incidence of secondary intervention, such as video-assisted thoracoscopic surgery (VATS), for persistent hemothorax Patients who received irrigation had a slight decrease in secondary intervention frequency Multi-center study -...
info_outline Episode 921: Pediatric HypoglycemiaEmergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: When it comes to hypoglycemia, the age dictates possible causes Neonate: Hormonal deficiency Congenital Adrenal Hyperplasia (21-hydroxylase deficiency, 11β-hydroxylase deficiency) Primary or Secondary Adrenal Insufficiency leading to cortisol deficiency Hypopituitarism Inborn errors of metabolism Systemic infection (Under 30 days old should trigger a full infectious workup) Toddler Accidental ingestions Sulfonylureas such as glipizide or glyburide Older children Addison’s Disease (Hypocortisolism) ...
info_outline Laboring Under Pressure Episode 3: Hypertensive Disorders of Pregnancy with Dr. Kiersten WilliamsEmergency Medical Minute
Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS3 Show Pearls Hypertensive disorders of pregnancy are one of the leading causes of maternal mortality worldwide. Hypertension (HTN) complicates 2-8% of pregnancies The definition of HTN in pregnancy is a systolic >140 or diastolic >90, measured 4 hours apart There is a range of HTN disorders Chronic HTN which could have superimposed preeclampsia (preE) on top Gestational HTN in which there are no lab abnormalities PreE w/o severe features Protein in urine Urine protein >300 mg in 24 hours Urine...
info_outline Episode 920: Pediatric Growth EstimatesEmergency Medical Minute
Contributor: Sean Fox, MD Educational Pearls: Newborns may lose up to 10% of their birth weight in the first week of life Weight loss is greatest in exclusively breastfed infants Should regain birth weight by age 2 weeks Newborns should gain an average of 30g (1 oz) per day in the first 3 months of life Some will gain more and some will gain less Infants double their birth weight by 6 months of life and triple their weight by 12 months A 1-year-old should weigh on average 10 kg (22 lbs) A 3-year-old should weigh on average 15 kg (33 lbs) 2-year-olds are between 10-15 kg...
info_outline Episode 919: EKG Criteria for AdenosineEmergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: SVT: supraventricular tachycardia Pharmacotherapy for SVT includes drugs that block the AV node, such as adenosine EKG criteria before adenosine administration in SVT Regular rhythm Monomorphic: all QRS complexes are identical If the EKG is polymorphic, with QRS complexes displaying changing morphologies, it is unsafe to administer adenosine Adenosine can worsen polymorphic VTach and lead to VFib References Ganz, Leonard I., and Peter L. Friedman. “Supraventricular Tachycardia.” New England Journal of...
info_outline Episode 918: Automated Blood Pressure CuffsEmergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: How does an automated blood pressure cuff work? Automated blood pressure cuffs work differently than taking a manual blood pressure. While taking a manual blood pressure, one typically listens for Korotkoff sounds (turbulent flow) while slowly deflating the cuff. An automatic blood pressure cuff only senses the pressure in the cuff itself and specifically pays attention to oscillations in the pressure caused by when the pressure of the cuff is between the systolic (heart squeezing) and diastolic (heart relaxed) pressures. These...
info_outline Episode 917: Heat-Related IllnessesEmergency Medical Minute
Contributor: Megan Hurley, MD Educational Pearls: Heat cramps Occur due to electrolyte disturbances Most common electrolyte abnormalities are hyponatremia and hypokalemia Heat edema Caused by vasodilation with pooling of interstitial fluid in the extremities Heat rash (miliaria) Common in newborns and elderly Due to accumulation of sweat beneath eccrine ducts Heat syncope Lightheadedness, hypotension, and/or syncope in patients with peripheral vasodilation due to heat exposure Treatment is removal from the heat source and rehydration (IV fluids or Gatorade) ...
info_outline Episode 916: Central Cord SyndromeEmergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: What is Central Cord Syndrome (CCS)? Incomplete spinal cord injury caused by trauma that compresses the center of the cord More common in hyperextension injuries like falling and hitting the chin Usually happens only in individuals with preexisting neck and spinal cord conditions like cervical spondylosis (age-related wear and tear of the cervical spine) Anatomy of spinal cord Motor tracts The signals the brain sends for the muscles to move travel in the corticospinal tracts of the spinal cord The tracts that control the...
info_outlineContributor: Megan Hurley, MD
Educational Pearls:
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Heat cramps
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Occur due to electrolyte disturbances
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Most common electrolyte abnormalities are hyponatremia and hypokalemia
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Heat edema
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Caused by vasodilation with pooling of interstitial fluid in the extremities
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Heat rash (miliaria)
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Common in newborns and elderly
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Due to accumulation of sweat beneath eccrine ducts
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Heat syncope
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Lightheadedness, hypotension, and/or syncope in patients with peripheral vasodilation due to heat exposure
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Treatment is removal from the heat source and rehydration (IV fluids or Gatorade)
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Heat exhaustion
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Patients have elevated body temperature (greater than 38º C but less than 40º C)
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Symptoms include nausea, tachycardia, headache, sweating, and others
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Normal mental status or mild confusion that improves with cooling
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Treatment is removal from the heat source and hydration
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Classic heat stroke
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From prolonged exposure to heat
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Defined as a core body temperature > 40.5º C, though not required for diagnosis or treatment
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Presentation is similar to heat exhaustion with the addition of neurological deficits including ataxia
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Patients present “dry”
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Exertional heat stroke
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Prolonged exposure to heat during exercise
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Similar to classic heat stroke but the patients present “wet” due to antecedent treatment in ice baths or other field treatments
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Management of heat-related illnesses includes:
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Cooling
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Rehydration
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Evaluation of electrolytes
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Antipyretics are not helpful because heat-induced illnesses are not due to hypothalamic dysregulation
References
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Casa DJ, McDermott BP, Lee EC, et al. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev 2007; 35:141.
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Ebi KL, Capon A, Berry P, et al. Hot weather and heat extremes: health risks. Lancet 2021; 398:698.
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Epstein Y, Yanovich R. Heatstroke. N Engl J Med 2019; 380:2449.
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Gardner JW, JA K. Clinical diagnosis, management, and surveillance of exertional heat illness. In: Textbook of Military Medicine, Zajitchuk R (Ed), Army Medical Center Borden Institute, Washington, DC 2001.
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Khosla R, Guntupalli KK. Heat-related illnesses. Crit Care Clin 1999; 15:251.
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Lipman GS, Gaudio FG, Eifling KP, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update. Wilderness Environ Med 2019; 30:S33.
Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce, MS1
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