Podcast 1015: Calcium in Hyperkalemia
Emergency Medical Minute
Contributor: Meghan Hurley, MD Educational Pearls: What is hyperkalemia? Hyperkalemia is when the measured blood level of potassium reaches above 5.2 - 5.5 mEq/L (normal 3.5 - 5.2 mEq/L). What are common causes of hyperkalemia? Chronic or acute kidney disease. Medications that impact the Renin-Angiotensin-Aldosterone-System (RAAS). Hypoaldosteronism and primary adrenal insufficiency (Addison’s Disease). What are concerns of hyperkalemia? The biggest concern with hyperkalemia is the impact on the cardiac conduction system. At differing levels of...
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Podcast 1014: Eating and Drinking on Shift
Emergency Medical Minute
Contributor; Aaron Lessen, MD Educational Pearls: A 2026 survey asked Canadian emergency medicine (EM) physicians about their eating and drinking habits while on shift. Among 527 respondents, 35% reported that they never or hardly ever ate during shifts, and 37% said the same about drinking water. Lack of time was the most commonly cited barrier, reported by 91% of respondents. Lack of available food, personal health goals, perceived mental clarity, and emergency department culture were also commonly identified factors. Physicians who did not eat or drink on shift often reported...
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Podcast 1013: Thoracotomy Indications
Emergency Medical Minute
Contributor; Taylor Lynch, MD Educational Pearls: Thoracotomy Thoracotomy is used in traumatic cardiac arrest to replace conventional CPR with direct access to the chest. Goals include identifying and controlling reversible causes of bleeding, prioritizing blood flow to the heart and brain, and performing open cardiac massage. Trauma categories Penetrating trauma: Gunshot wounds and stab wounds. Has a higher chance of survival because the injury may be localized and directly repairable. Cardiac stab wounds may have the highest survivability because the defect can be...
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Podcast 1012: Meth Sedation
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Agitated patients who are intoxicated with methamphetamine pose a unique challenge when selecting a sedative to counter their symptoms. Is there a superior medication? A recent study compared the efficacy of commonly used medications for methamphetamine-induced agitation in the emergency department. The study compared IM Droperidol 5mg, IM Olanzapine 10mg, IM Midazolam 5mg, and IM Lorazepam 2mg. The study concluded that Droperidol, Olanzapine, and Midazolam performed similarly, with a median time to adequate sedation of...
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Podcast 1011: Creepy Crawlies
Emergency Medical Minute
Contributor: Meghan Hurley, MD Educational Pearls: What animal is the most lethal to humans? Depending on how we define lethal, and animal, this answer is actually not straight forward. Globally and in the U.S. the most lethal animal is humans, accounting for ~436,000 to ~20,000 deaths (homicides) per year on average respectively. In the United States the most lethal animal is of the Hymenoptera order (bees, wasps, and hornets). It accounts for approximately ~60 deaths per year from anaphylaxis. Globally the number is harder to track, but is estimated between...
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Podcast 1010: First Pass Intubation Success
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma. Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt How to improve likelihood of first-pass success: Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71% Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study...
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On the Streets- Zero to Rodeo
Emergency Medical Minute
Dan Orbidan, OMS-II and Dr. Travis Barlock, MD discuss a real out of hospital call. This episode covers the implications of a pharmacologically abnormal patient presentation and the pre and post hospital considerations for patient management and care.
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Carepoint Journal Club- Neurology
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 1009: Prevention for Recurrent UTI
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment. UTI signs and symptoms Burning sensation when urinating Strong urge to urinate Urinating often and passing small amounts of urine. Pelvic pain There are currently more guidelines and studies on treatments to prevent these...
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Podcast 1008: Acupuncture for Low Back Pain in Older Adults
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Back pain is a common presenting complaint in the emergency department. Challenges arise when tailoring care to elderly populations using standard medical therapy: Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion. Pain medications such as opiates have side effects including constipation, respiratory depression, and hypotension. NSAIDs carry a risk of GI bleeding and worsening kidney function with chronic use. A randomized clinical trial assessing the effects...
info_outlineContributor: Meghan Hurley, MD
Educational Pearls:
What animal is the most lethal to humans?
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Depending on how we define lethal, and animal, this answer is actually not straight forward.
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Globally and in the U.S. the most lethal animal is humans, accounting for ~436,000 to ~20,000 deaths (homicides) per year on average respectively.
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In the United States the most lethal animal is of the Hymenoptera order (bees, wasps, and hornets). It accounts for approximately ~60 deaths per year from anaphylaxis. Globally the number is harder to track, but is estimated between 250–3,800 deaths globally annually.
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Globally the most lethal animal is venomous snakes, accounting for between 60,000-150,000 per year (whereas in the United States this number is closer to ~5).
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Mosquitos, as a vector however for the pathogens they transmit, out rank all as the most lethal globally (excluding humans).
What are the key take-aways for each insect discussed in this episode?
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Mosquitos:
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In the United States, of lesser concern. Can potentially transmit West Nile Virus in the United States. Otherwise, treatment for general mosquito bites is topical antihistamines and over the counter steroid creams.
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Hymenoptera order (bees, wasps, and hornets):
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Distributed throughout the US, and can also live in the ground.
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Bees lose their stinger during a sting. Whereas wasps do not and can sting multiple times.
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Typically stings are just localized for symptoms (pain and swelling) but can become anaphylactic.
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Treat with IM Epinephrine as the first line. Consider bronchodilators from bronchospasms.
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Multiple stings (around ~100), can cause end organ damage and rhabdomyolysis outside of just anaphylaxis alone. Require more aggressive management.
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Fire Ants:
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Behave similar to bees (in swarm mentality), but have differing venoms. Can also cause global symptoms.
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Black Widow:
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No deaths from Latrodectus hesperus (Western Black Widow) recorded in the United States. There are 3 deaths globally from widow species. Two from Madagascar, and one from a Mediterranean species of widow.
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Debate in the toxicology community about use of the antivenom, which may account for more deaths than the bite itself.
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Black Widow bites are typically painful. Which is different from bites from recluse species.
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Brown Recluse:
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Rare in Colorado
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Typically painless bite, that creates a center necrotic eschar.
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Tend to also not be lethal.
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Bed Bugs
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Typically harmless and more of a nuisance to have. Can cause localized infections.
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Bite presents in a “Breakfast, Lunch, and Dinner” formation (i.e. linear 2-3 or more bites as the bug tracks and feeds on skin).
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Will feed primarily on exposed skin.
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The biggest concern is ensuring no cross contamination from patient to provider or facility.
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Bed bug bite delivers a small amount of local anesthetic, which can make them hard to detect.
References
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Haskell MG, Langley RL. Animal-Encounter Fatalities, United States, 1999-2016: Cause of Death and Misreporting. Public Health Rep. 2020;135(6):831-841. doi:10.1177/0033354920953211
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Herness J, Snyder MJ, Newman RS. Arthropod Bites and Stings. AFP. 2022;106(2):137-147.
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GBD 2019 Snakebite Envenomation Collaborators. Global mortality of snakebite envenoming between 1990 and 2019. Nat Commun. 2022;13(1):6160. doi:10.1038/s41467-022-33627-9
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Wei YL, Wu Z, Li RL, Tang F. Review of selected mosquito-borne diseases: arboviruses (dengue, chikungunya, Zika, West Nile, Japanese encephalitis, yellow fever) and parasitic diseases (malaria, lymphatic Filariasis). Front Public Health. 2025;13:1712094. doi:10.3389/fpubh.2025.1712094
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Forsberg K, Sheats KJ, Blair JM, et al. Surveillance for Violent Deaths - National Violent Death Reporting System, 50 States, the District of Columbia, and Puerto Rico, 2022. MMWR Surveill Summ. 2025;74(5):1-42. doi:10.15585/mmwr.ss7405a1
Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P
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