Tox Talks 2025 Recap 2, Methemoglobinemia and Errors
Release Date: 02/04/2026
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...
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Podcast 996: Melatonin
Emergency Medical Minute
Contributor: Taylor Lynch MD Educational Pearls: Melatonin is an endogenous hormone released primarily by the pineal gland Also released by extrapineal regions in the retina, the GI tract, and some immune cells Peak secretion occurs at night and is suppressed during the day Secretion and production decrease with age Older patients experience the greatest improvement in sleep latency and sleep quality Mechanism of action in the suprachiasmatic nucleus of the hypothalamus MT1 receptor Reduces normal firing MT2 receptor Shifts the circadian rhythm FDA approved for insomnia ...
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Episode 995: UTI Diagnosis
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: Foul-smelling urine and cloudy urine are commonly misinterpreted as indicators of a UTI. However, these findings alone are not diagnostic. Criteria for UTI: Presence of localized urinary symptoms: Suprapubic pain Dysuria Hesitancy Urgency Urinalysis with WBC > 10 Urine culture with > 100,000 CFU/mL Colonization differs from infection - many patients harbor asymptomatic bacteria but do not have a true infection. Consequences of overtreatment One review showed 45% of patients treated with antibiotics for a presumed UTI...
info_outlineContributors: Travis Barlock MD, Ian Gillman PA, Jacob Altholz MD, Jeffrey Olson MS4
In this episode, EM attending Travis Barlock and medical student Jeffrey Olson listen in to the two remaining cases presented from EMM’s recent event, Tox Talk 2025.
Talk 1- Methemoglobinemia- Ian Gillman
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Cyanosis + chocolate-colored blood + normal PaO₂ + pulse ox stuck at ~85% = Methemoglobinemia → Treat with methylene blue
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The medications that can cause it can be remembered with…
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Watch out with methylene blue as it can cause serotonin syndrome
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While treating with methylene blue the pulse ox can drop dramatically but this is not a real drop in oxygenation but rather an effect of how the methylene blue affects the sensor
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BADNAPS: causes of methemoglobinemia
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Benzocaine
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Aniline Dyes
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Dapsone
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Nitrites/Nitrates (Found in meds, preservatives, and well water)
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Antimalarials
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Pyridium
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Sulfonamides
Talk 2- Intratecal TXA and Hierarchy of Controls for Error Avoidance - Jacob Altholz
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Hierarchy of Controls in terms of error prevention includes all of the layers of protection which can be categorized as elimination, substitution, engineering controls, administration controls, and PPE
References
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Centers for Disease Control and Prevention. (2022, April 28). Hierarchy of controls. National Institute for Occupational Safety and Health. https://www.cdc.gov/niosh/learning/safetyculturehc/module-3/2.html
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Pushparajah Mak RS, Liebelt EL. Methylene Blue: An Antidote for Methemoglobinemia and Beyond. Pediatr Emerg Care. 2021 Sep 1;37(9):474-477. doi: 10.1097/PEC.0000000000002526. PMID: 34463662.
Produced by Jeffrey Olson, MS4
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