Emergency Medical Minute
Emergency Medical Minute is medicine's most prolific podcast. Geared towards physicians, nurses and paramedics! Tune in weekly for real, raw and relevant medical education.
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COVID-19 Digest: If You’ve Had COVID-19, Can You Get it Again? / Convalescent Serum (Recorded 3/26/20, 18:00 MST)
03/27/2020
COVID-19 Digest: If You’ve Had COVID-19, Can You Get it Again? / Convalescent Serum (Recorded 3/26/20, 18:00 MST)
Host: Elizabeth Esty, MD Research By: Elizabeth Esty and Nathan Novotny References: Osumi M. Questions raised over COVID-19 reinfection after Japanese woman develops illness again. The Japan Times. https://www.japantimes.co.jp/news/2020/02/28/national/coronavirus-reinfection/#.Xn4coZNKhQI. Published February 28, 2020. Bao L, Deng W, Gao H, et al. Reinfection could not occur in SARS-CoV-2 infected rhesus macaques. bioRxiv. March 2020:2020.03.13.990226. doi:10.1101/2020.03.13.990226 Steinbuch Y. Doctor asks recovered coronavirus patients to be tested for antibodies. New York Post. https://nypost.com/2020/03/26/doctor-asks-recovered-coronavirus-patients-to-be-tested-for-antibodies/. Published March 26, 2020. Casadevall A. How a Boy’s Blood Stopped an Outbreak. The Wall Street Journal. https://www.wsj.com/articles/how-a-boys-blood-stopped-an-outbreak-11582847330. Published February 27, 2020. U.S. Food and Drug Administration. Investigational COVID-19 Convalescent Plasma - Emergency INDs.https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds. Published March 24, 2020. Carmichael T. Takeda Pharmaceutical Announces a Plasma-Derived Coronavirus Therapy. Nasdaq. https://www.nasdaq.com/articles/takeda-pharmaceutical-announces-a-plasma-derived-coronavirus-therapy-2020-03-04. Published March 4, 2020. Maxmen A. How blood from coronavirus survivors might save lives. Nature. March 2020. https://www.nature.com/articles/d41586-020-00895-8. Amanat F, Nguyen T, Chromikova V, et al. A serological assay to detect SARS-CoV-2 seroconversion in humans. medRxiv. March 2020:2020.03.17.20037713. doi:10.1101/2020.03.17.20037713 Steinbuch Y. Mount Sinai researchers develop test for coronavirus antibodies. New York Post. https://nypost.com/2020/03/24/mount-sinai-researchers-develop-test-for-coronavirus-antibodies/. Published March 24, 2020.
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ER Doc Infected with COVID-19 Shares Experience
03/27/2020
ER Doc Infected with COVID-19 Shares Experience
Recorded 3/26/20
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COVID-19: Hydroxychloroquine & Azithromycin / Anosmia / The Aerosolized vs. Droplet Debate (Recorded 3/24/20, 18:00 MST)
03/25/2020
COVID-19: Hydroxychloroquine & Azithromycin / Anosmia / The Aerosolized vs. Droplet Debate (Recorded 3/24/20, 18:00 MST)
The circumstances surrounding the COVID-19 virus are quickly evolving and that means that EMM will have to as well. For the foreseeable future, EMM will be releasing COVID-19 updates. In this series, we will report the most recent statistics, summarize the newest literature and answer YOUR burning questions. Submit your questions through comments on this post or through private messages on any of our social media platforms. Host: Elizabeth Esty, MD Research By: Elizabeth Esty, Jackson Roos, Nathan Novotny & Mason Tuttle Time Stamps: 0:00 - COVID-19 by the numbers 2:50 - Hydroxychloroquine and Azithromycin 6:05 - Ongoing Anti-Viral Therapy Research 7:47 - Anosmia 9:31 - Viability of COVID-19 Aerosolized vs. on Surfaces 10:49 - Listener Questions References: The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University Interactive Map Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label nonrandomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 –DOI : 10.1016/j.ijantimicag.2020.105949 Belhadi D, Peiffer-Smadja N, Yazdanpanah Y, Mentré F, Laouénan C. A brief review of antiviral drugs evaluated in registered clinical trials for COVID-19. medRxiv. March 2020:2020.03.18.20038190.doi:10.1101/2020.03.18.20038190 Hopkins C, Kumar N, ENT UK at The Royal College of Surgeons of England. Loss of sense of smell as marker of COVID-19 infection. https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf.
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Podcast 551: PPIs are Not Benign
03/23/2020
Podcast 551: PPIs are Not Benign
Contributor: Don Stader, MD Educational Pearls: PPIs (Proton pump inhibitors) reduce stomach acid levels and are commonly prescribed in patients with GERD or peptic ulcer disease Stopping a PPI after sustained use for a month or longer can lead to withdrawal - causing a rebound indigestion or reflux due to a surge in acid production Long term PPI use has noteworthy side effects including increased incidence of bacterial GI infections and pneumonia Be cautious in prescribing a PPI for over 2 weeks. If continued indigestion control is needed, transition to a H2 blocker or OTC antacids if prolonged treatment is needed. References Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE (2018) Side effects of long-term proton pump inhibitor use: a review. Basic Clin Pharmacol Toxicol 123(2):114–121. https://doi.org/10.1111/bcpt.13023 Review Helgadottir, H.; Bjornsson, E.S. Problems Associated with Deprescribing of Proton Pump Inhibitors. Int. J. Mol. Sci. 2019, 20, 5469. Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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On the Streets #3: COVID-19
03/19/2020
On the Streets #3: COVID-19
In this special edition of our On the Streets podcast, we discuss COVID-19 as well as what first responders and emergency providers need to know to keep themselves and their patients safe during this pandemic.
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Podcast 550: Good ol’ Versed
03/17/2020
Podcast 550: Good ol’ Versed
Contributor: Sam Killian, MD Educational Pearls: Agitation can be due to a number of causes, but regardless of the cause, sedation often plays a key role in patient and provider safety. But what is the best sedative agent? A study looked at control of agitation with intramuscular medication. Specifically, 5 different IM sedative agents were compared to see which one best provides “adequate” sedation in 15 minutes or less. Haldol 5mg, Haldol 10mg, Versed 5mg, Zyprexa 10mg, and Geodon 20mg were all compared, and by far Versed provided the best sedative results. All medications had approximately the same amount of adverse effects. There are so many sedative options, but time and time again large dose benzodiazepines have demonstrated great effectiveness in treating acute agitation References Klein, Lauren R. et al. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department. Annals of Emergency Medicine. 2018. 72(4), 374 - 385 Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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Podcast 549: Just Use Epineprhine
03/16/2020
Podcast 549: Just Use Epineprhine
Contributor: Sam Killian, MD Educational Pearls: Classic dogma teaching that epinephrine should not be used in the fingers, nose, penis, and toes when performing local anesthesia due to concerns for ischemia is wrong This has been well documented in multiple literature reviews A prospective, randomized double-blind study compared lidocaine vs lidocaine with epinephrine for finger injuries and the use of epinephrine was associated with less bleeding and better anesthesia Editor’s note: in the lidocaine without epinephrine group, 5 (not 7) needed additional dosing of local anesthesia. The groups were also split 29 for lidocaine alone and 31 for lidocaine with epinephrine but we’re in a pandemic so who is noticing anyways References . Wilhelmi, B.J., et al. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg. 2001 Feb;107(2):393-7. . Ilicki, J. Safety of Epinephrine in Digital Nerve Blocks: A Literature Review. J Emerg Med. 2015 Nov;49(5):799-809. doi: 10.1016/j.jemermed.2015.05.038. Epub 2015 Aug 4. . Walsh, K., Baker, B.G., Iyer, S. Adrenaline Auto-injector injuries to digits; a systematic review and recommendations for emergency management. 2020 Feb 8. pii: S1479-666X(20)30016-0. doi: 10.1016/j.surge.2020.01.005. Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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On the Streets #2: Neurological Deficits
03/11/2020
On the Streets #2: Neurological Deficits
Part 1 of 2: Dr. Adam Graham dishes out the essentials of identifying concerning neurological deficits on the scene, predicting what they mean and how to best care for patients with neurological deficits in the pre-hospital setting. About Dr. Adam Graham: Adam Graham, MD, is a board-certified neurologist with Blue Sky Neurology in Denver. His professional interests include treatment of diseases of the peripheral nerves and muscles, for example ALS, myasthenia gravis and peripheral neuropathy. He works to make EMG procedures as comfortable as possible for patients. Dr. Graham earned his medical degree from Creighton University. He then completed a residency in neurology and a fellowship in neuromuscular medicine and EMG, both at the University of Colorado.
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Podcast 548: Adrenal Crisis
03/10/2020
Podcast 548: Adrenal Crisis
Contributor: Nick Tsipis, MD Educational Pearls: Congenital adrenal hyperplasia (CAH) is a group of enzyme deficiencies in the adrenals leading to a deficiency of hormones normally synthesized by the adrenals (mineralocorticoids, glucocorticoids, androgens) 21-hydroxylase is most commonly the deficient enzyme. 21-hydroxylase is needed to produce aldosterone and cortisol, and those with chronic cortisol deficiencies need daily steroid replacement Aldosterone, made in the kidney as part of the renin-angiotensin-aldosterone system (RAAS), increases blood pressure via salt and water retention to maintain adequate organ perfusion Adrenal crisis results in a loss of cortisol leading to hypoglycemia and potential CNS depression with hypotension, hypoglycemia, and hyponatremia Patients in adrenal crisis need salt, volume, and glucose replacement References Martin-Grace, J., et al. Adrenal insufficiency: physiology, clinical presentation and diagnostic challenges. Clin Chim Acta. 2020 Feb 6. Dineen, R., Thompson, C.J., Sherlock, M. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. 2019 Jun 13;10:2042018819848218. El-Maouche, D., Arlt, W., Merke, D.P. Congenital Adrenal Hyperplasia. Lancet. 2017 Nov 11;390(10108):2194-2210. Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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Podcast 547: Capsaicin Cream to the Rescue
03/09/2020
Podcast 547: Capsaicin Cream to the Rescue
Author: Aaron Lessen, MD Educational Pearls: A recent retrospective study looked capsaicin cream in treating cannabinoid hyperemesis syndrome in regards to length of stay, cost analysis, use of rescue therapies, and adverse events Results showed a trend towards reduced length of stay but did not reach statistical significance Use of opioids was reduced in the capsaicin group Capsaicin remains a potential treatment option in this often difficult disease References Samantha Wagner, Jason Hoppe, Matthew Zuckerman, Kerry Schwarz & Julie McLaughlin (2019) Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department, Clinical Toxicology, DOI: Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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Podcast 546: Complete Heart Block
03/03/2020
Podcast 546: Complete Heart Block
Author: Jared Scott, MD Educational Pearls: Differentiating symptomatic bradycardia from asymptomatic may be essential in determining workup and treatment Airway, breath, circulation always hold true Symptoms may include dizziness, syncope, or weakness An EKG is essential in the majority of cases Complete heart block can be a cause of symptomatic bradycardia and requires immediate attention Complete heart block can be caused by drugs (beta-blockers, calcium channel blockers), Lyme disease, infiltrative disease, or degeneration of the conduction system References: Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(7):e51. Epub 2018 Nov 6. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 545: So You Quit Smoking… Now What?
03/02/2020
Podcast 545: So You Quit Smoking… Now What?
Author: Aaron Lessen, MD Educational Pearls: New data shows within 5 years of smoking cessation, the risk of cardiovascular disease becomes half of those who continue to smoke After 10-15 years of cessation, cardiovascular disease rates return to rates seen in non-smokers. Lung disease, COPD, and cancer rates do not decrease quite as rapidly, but do decrease It’s important to remind patients of the long-term health benefits associated with smoking cessation when counseling them. References Duncan MS, Freiberg MS, Greevy RA, Kundu S, Vasan RS, Tindle HA. JAMA. 2019;322(7):642–650. doi:10.1001/jama.2019.10298 Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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UnfilterED #5: Dr. Lisa Zwerdlinger
02/26/2020
UnfilterED #5: Dr. Lisa Zwerdlinger
Recorded remotely in the highest hospital in the world, Nick sits down to talk with Dr. Lisa Zwerdlinger, a small-town physician who's worn many different hats both in the hospital and her community. Intro Music: Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/
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Podcast 544: C is for Sepsis
02/25/2020
Podcast 544: C is for Sepsis
Author: Aaron Lessen, MD Educational Pearls: Previously, trials had shown promising evidence that vitamin C may improve mortality rates in patients with sepsis or septic shock. A 2017 retrospective before-after study gave a “cocktail” of hydrocortisone, vitamin C, and thiamine to patients with severe sepsis or in septic shock and reported a decrease in mortality from 40% to 8%. A 2020 randomized controlled trial demonstrated that giving patients hydrocortisone, vitamin C, and thiamine showed no benefits in improving sepsis outcomes. Currently use of Vitamin C in sepsis and septic shock remains controversial due to lack of sufficient data References Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229. Epub 2016 Dec 6. Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423–431. doi:10.1001/jama.2019.22176 Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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Podcast 543: Scoring Blunt Traumatic Aortic Injury
02/24/2020
Podcast 543: Scoring Blunt Traumatic Aortic Injury
Author: Nick Tsipis, MD Educational Pearls: Aortic injury caused by blunt trauma is very rare Chest x-ray findings might include widening of the mediastinum Ligamentum arteriosum (remnant of the ductus arteriosus) tethers the aorta to the chest wall, potentially causing injury with abrupt decelerations and motion XR lacks significant sensitivity (around 75%) to be utilized in many cases CT angiogram (CTA) of the chest is typically the preferred test but comes with potential risks including radiation exposure is a scoring tool that may provide value in determining the need for additional imaging References Yu L, Baumann BM, Raja AS, Mower WR, Langdorf MI, Medak AJ, Anglin DR, Hendey GW, Nishijima D, Rodriguez RM. Blunt Traumatic Aortic Injury in the Pan-scan Era. Acad Emerg Med. 2019 Dec 7. doi: 10.1111/acem.13900. Summarized and edited by Erik Verzemnieks, MD
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Mental Health Monthly #2: Non-Epileptic Seizures (NES)
02/19/2020
Mental Health Monthly #2: Non-Epileptic Seizures (NES)
Non Epileptic Seizures (NES) is perhaps one of the most misunderstood and overlooked disorders that emergency medicine professionals encounter. Dr. Randi Libbon & Dr. Laura Strom, both experts on NES, explain the ongoing research surrounding the topic as well as how to best manage patients with NES in the emergency setting. To learn more about Dr. Randi Libbon: To learn more about Dr. Laura Strom: References & Further Reading: Baslet G, Seshadri A, Bermeo-Ovalle A, Willment K, Myers L. Psychogenic Non-epileptic Seizures: An Updated Primer. Psychosomatics. 2016;57(1):1-17. doi:10.1016/j.psym.2015.10.004 Perez DL, LaFrance WC. Nonepileptic Seizures: An Updated Review. CNS Spectr. 2016;21(3):239-246. doi:10.1017/S109285291600002X Libbon R, Gadbaw J, Watson M, et al. The feasibility of a multidisciplinary group therapy clinic for the treatment of nonepileptic seizures. Epilepsy Behav. 2019;98:117-123. doi:10.1016/j.yebeh.2019.06.032 Ding J-R, An D, Liao W, et al. Altered Functional and Structural Connectivity Networks in Psychogenic Non-Epileptic Seizures. PLoS ONE. 2013;8(5). doi:10.1371/journal.pone.0063850 Allendorfer JB, Nenert R, Hernando KA, et al. FMRI response to acute psychological stress differentiates patients with psychogenic non-epileptic seizures from healthy controls – A biochemical and neuroimaging biomarker study. NeuroImage Clin. 2019;24:101967. doi:10.1016/j.nicl.2019.101967
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Podcast 542: Nasogastric Tubes
02/18/2020
Podcast 542: Nasogastric Tubes
Author: Don Stader, MD Educational Pearls: Nasogastric tubes (NGT) are very uncomfortable for all those involved but some simple tricks and tips may help: Topical lidocaine can be inserted into the nasal passage for local analgesia Afrin may help shrink the mucosal tissue of the nasal turbinates as well Molding the tube with cold/ice water can help - putting it in an ice bath with an endotracheal tube stylet will allow you to mold the tip to your preference References Lor YC, Shih PC, Chen HH, et al. The application of lidocaine to alleviate the discomfort of nasogastric tube insertion: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(5):e9746. doi:10.1097/MD.0000000000009746 https://www.acepnow.com/article/making-ng-tube-placement-less-horrendous/ https://www.aliem.com/trick-of-trade-making-ng-and-np-painless/ Summarized and edited by Erik Verzemnieks, MD
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Podcast 541: Needle Thoracostomy
02/17/2020
Podcast 541: Needle Thoracostomy
Author: Aaron Lessen, MD Educational Pearls: Traditional technique of needle thoracostomy for tension penumothorax is along the 2nd intercostal space at the midclavicular line Inserting a large angiocatheter along the 4th or 5th intercostal space at the mid-axillary line may provide a thinner area that is more easily identified, overcoming many of the obstacles of the traditional approach The 10th Edition of ATLS now recommends this location as well A finger thoracostomy, where a scalpel and then the finger are used to penetrate the pleural cavity at the same location, is another method to provide quick decompression of a traumatic tension pneumothorax, allowing a tube thoracostomy to be performed later References Laan DV, Vu TD, Thiels CA, et al. Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016;47(4):797–804. doi:10.1016/j.injury.2015.11.045 Inaba K, Branco BC, Eckstein M, Shatz DV, Martin MJ, Green DJ, Noguchi TT, Demetriades D. Optimal positioning for emergent needle thoracostomy: a cadaver-based study. J Trauma. 2011 Nov;71(5):1099-103; discussion 1103. doi: 10.1097/TA.0b013e31822d9618. Summarized and edited by Erik Verzemnieks, MD
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On the Streets #1: The Art of the Handoff Report
02/12/2020
On the Streets #1: The Art of the Handoff Report
EMM is proud to present the pilot episode of our new monthly series, “On the Streets”. This will be an informative podcast for all of our listeners, but this one was designed specifically for our EMS listeners. Each month, we will consult medical experts on topics pertinent to prehospital care: Identifying a posterior circulation stroke in the field; Knowing when to do a 12-lead and what to look for; How to use capnography for a variety of datapoints; How to give an effective handoff report. And much much more... On our first episode, we are proud to welcome long-time friend of EMM, now retired Emergency Physician and current Medical Director of the ACC EMS program, Dr. Michael Hunt. This episode focuses exclusively on the Do's and Don'ts of giving handoff report. As we all know, knowledge and timing can make a world of difference when treating acutely ill patients. Like all of our content, we aim to equip you with the resources to forge your medical knowledge while keeping it relevant and time-efficient. Tune into “On the Streets” for real, raw and relevant EMS education. Photo Credit:
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Podcast 540: Zyprexa
02/11/2020
Podcast 540: Zyprexa
Contributor: Don Stader, MD Educational Pearls: Olanzapine (Zyprexa) is an atypical antipsychotic that can be used in a similar fashion to haloperidol for pain and nausea, including that with abdominal pain and headaches Olanzapine can be administered as an oral disolving tablets, intramuscular or intravenous injection Because Zyprexa is an atypical antipsychotic, it has a lower risk for tardive dyskinesia and akathisia Olanzapine may cause transient rises in glucose and should be considered when contemplating use in a diabetic References Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults.Sutherland A, Naessens K, Plugge E, Ware L, Head K, Burton MJ, Wee B. Cochrane Database Syst Rev. 2018;9:CD012555. Epub 2018 Sep 21. Silberstein, S.D., Peres, M.F., Hopkins, M.M., Shechter, A.L., Young, W.B. and Rozen, T.D. (2002), Olanzapine in the Treatment of Refractory Migraine and Chronic Daily Headache. Headache: The Journal of Head and Face Pain, 42: 515-518. doi: Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 539: Coricidin Abuse
02/10/2020
Podcast 539: Coricidin Abuse
Contributor: Rachel Beham, PharmD Educational Pearls: Coricidin HBP Cough & Cold (dextromethorphan and chlorpheniramine) is one of the more commonly abused over-the-counter medications Dextromethorphan, binds to multiple receptors, particularly at high doses Opioid receptors, causing respiratory depression, CNS depression NMDA receptors, causing agitation and hallucinations Serotonin-reuptake inhibition, which may lead to serotonin syndrome, especially when combined with other agents Dextromethorphan also contains bromide, which when chronically abused can lead to bromism (behavioral changes, hallucinations, weight loss, and neurologic changes) Chlorpheniramine is an antihistamine and can cause anticholinergic effects in overdose, such agitation, hyperthermia, and hallucinations Acute treatment of Coricidin abuse is mostly supportive, which may include benzodiazepines, naloxone, dialysis, sodium bicarbonate, and physostigmine depending on the predominate toxidrome and symptoms present References Ritter D, Ouellette L, Sheets JD, Riley B, Judge B, Cook A, Houseman J, Jones JS. "Robo-tripping": Dextromethorphan toxicity and abuse. Am J Emerg Med. 2019 Nov 17. pii: S0735-6757(19)30655-2. doi: 10.1016/j.ajem.2019.10.001. Bryner JK, Wang UK, Hui JW, Bedodo M, MacDougall C, Anderson IB. Dextromethorphan abuse in adolescence: an increasing trend: 1999-2004. Arch Pediatr Adolesc Med. 2006;160(12):1217–1222. doi:10.1001/archpedi.160.12.1217 Monks S, Yen M, Myers J. Bromism: An overlooked and elusive toxidrome from chronic dextromethorphan abuse. Am J Emerg Med. 2019 Nov 15:158491. doi: 10.1016/j.ajem.2019.158491. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 538: Low Maintenance Boxer’s Fracture
02/04/2020
Podcast 538: Low Maintenance Boxer’s Fracture
Contributor: Jared Scott, MD Educational Pearls: A distal 5th metacarpal neck fracture is often referred to as a “boxer’s fracture” and a common fracture encountered in the emergency department Splinting with an ulnar gutter splint is the typical management of uncomplicated boxer’s fractures A recent study randomized patients to buddy taping or ulnar gutter splint for uncomplicated Boxer’s fractures. Similar functional and pain outcomes were found at follow-up, and those in the buddy taping group returned to work more quickly. One limitation was nearly 20% of study patients were lost to follow up Editor’s note: remember - this only applies to a true boxer’s fracture, which is a distal 5th metacarpal neck fracture, not just any 5th metacarpal shaft fracture References Richard Pellatt, Igor Fomin, Carli Pienaar, Randipsingh Bindra, Michael Thomas, Ezekiel Tan, Cindy Mervin, Ping Zhang, Gerben Keijzers. Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial, Annals of Emergency Medicine, Volume 74, Issue 1, 2019, Pages 88-97, Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 537: Thoughts on Cardiac Arrest
02/03/2020
Podcast 537: Thoughts on Cardiac Arrest
Contributor: Don Stader, MD Educational Pearls: High-quality compressions are an essential, and probably one of the most important, part of cardiac arrest Actual evidence for drugs in cardiac arrest included in ACLS are limited, including epinephrine, bicarbonate, amiodarone, etc. Early defibrillation for ventricular tachycardia (VT) or ventricular fibrillation (VF) has a plethora of supporting evidence Double-sequential defibrillation (nearly simultaneous defibrillation using 2 machines) may be considered for refractory dysrhythmias like VF tPA during a cardiac arrest can be considered in the setting of massive PE (although the evidence supporting this practice is poor) Ending a cardiac arrest resuscitation is a difficult decision and use of ultrasound may be helpful to assess for meaningful cardiac function/activity References Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW . Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov;132(18 Suppl 2):S444-64. Wang Y, Wang M, Ni Y, Liang B, Liang Z. Can Systemic Thrombolysis Improve Prognosis of Cardiac Arrest Patients During Cardiopulmonary Resuscitation? A Systematic Review and Meta-Analysis.J Emerg Med. 2019;57(4):478. Epub 2019 Oct 5. Eric Cortez, William Krebs, James Davis, David P. Keseg, Ashish R. Panchal. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation. Volume 108. 2016. Pages 82-86, Atkinson PR, Beckett N, French J, Banerjee A, Fraser J, Lewis D. Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus. 2019;11(4):e4456. Published 2019 Apr 13. doi:10.7759/cureus.4456 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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UnfilterED #4: Dr. Vivek Tayal
01/29/2020
UnfilterED #4: Dr. Vivek Tayal
Dr. Vivek Tayal of Carolinas Medical Center, a pioneer of using ultrasound in the emergency department, reflects on his role in establishing ultrasound use in emergency medicine and much more! Ultrasound Program Management: Intro Music: Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/
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Podcast 536: Epistaxis 101
01/28/2020
Podcast 536: Epistaxis 101
Contributor: Dylan Luyten, MD Educational Pearls: Clear the nasal passages - have the patient, if stable, blow their nose to dislodge any clot that might be in the way Searching for the source of bleeding can be tough. Majority of anterior bleeding is from Kesselbach’s plexus Placing a clamp to provide direct pressure is a mainstay of treatment Application of a topical agent, which may include lidocaine epinephrine tetracaine (LET), tranexamic acid (TXA), or oxymetazoline Nasal packing with a nasal balloon or merocel may be necessary if bleeding persists Posterior epistaxis can be potentially devastating - for all practical purposes are epistaxis that does not resolve with anterior packing Interventional radiology can be a helpful consultant for controlling of posterior epistaxis, and may be just as or more helpful than ENT References Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(7):744-749. Shargorodsky J, Bleier B, Holbrook E, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-398. Singer A, Blanda M, Cronin K, et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med. 2005;45(2):134-139. , . Epistaxis: Outpatient Management. Am Fam Physician. 2018 Aug 15;98(4):240-245. , , , , , . Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature. Am J Emerg Med. 2008 May;26(4):516.e3-5. doi: 10.1016/j.ajem.2007.07.036. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 535: A Prescription for Falls
01/28/2020
Podcast 535: A Prescription for Falls
Contributor: Aaron Lessen, MD Educational Pearls: Emergency department evaluation of falls, particularly in the elderly, should include an assessment of risk factors Common causes of falls in the elderly include medications. Review medication list for sedating medications amongst others Consult with your hospital physical therapist to discuss fall prevention techniques with the patient One study has shown that a comprehensive interdisciplinary approach to geriatric falls in the ED can reduce return visits and hospital admissions. References Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc. 2004;52(9):1417–23. Albert M, Rui P, McCaig LF. Emergency department visits for injury and illness among adults aged 65 and over: United States, 2012-2013. NCHS Data Brief. 2017;(272):1–8. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Mental Health Monthly #1: Decision Making Capacity
01/22/2020
Mental Health Monthly #1: Decision Making Capacity
In the first episode of this new series, the complexities of decision making capacity are discussed. References and Further Reading: Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. Etchells, E., Darzins, P., Silberfeld, M., Singer, P. A., McKenny, J., Naglie, G., ... & Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of general internal medicine, 14(1), 27-34.
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Podcast 534: Nerve Agents
01/21/2020
Podcast 534: Nerve Agents
Author: Michael Hunt, MD Educational Pearls: Organophosphate “nerve agents” were developed in the 1930’s These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE” Salivation Lacrimation Urination Defecation GI cramping Emesis The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis Treatment includes atropine to reduce secretions (often in incredibly high doses) and pralidoxime (2-PAM) to treat muscle paralysis Benzodiazepines may be necessary for seizures References Michael Eddleston . Annual Review of Pharmacology and Toxicology 2019 59:1, 341-360 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 533: Hypoglycemia
01/20/2020
Podcast 533: Hypoglycemia
Contributor: Dylan Luyten, MD Educational Pearls: Insulin related hypoglycemia can vary from a brief transient effect from short-acting forms (i.e. insulin lispro) to prolonged from long acting (i.e. insulin glargine), and will require different treatment and/or observation Of oral glycemic agents, sulfonylureas are a common culprit while metformin is rarely a cause Sulfonylureas also deserve attention because in pediatric patients, they can be lethal even with a single ingestion, but also can cause severe hypoglycemia in adults Hypoglycemia in non-diabetics usually occurs in the malnourished, or in those with liver or adrenal disease References Klein-Schwartz W, Stassinos GL, Isbister GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol. 2016;81(3):496–504. doi:10.1111/bcp.12822 Tourkmani AM, Alharbi TJ, Rsheed AMB, AlRasheed AN, AlBattal SM, Abdelhay O, Hassali MA, Alrasheedy AA, Al Harbi NG, Alqahtani A. Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article. Diabetes Metab Syndr. 2018 Sep;12(5):791-794. doi: 10.1016/j.dsx.2018.04.004. Epub 2018 Apr 12. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 532: SVC Syndrome
01/14/2020
Podcast 532: SVC Syndrome
Contributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing, and parasthesias Common causes of SVC syndrome include lung cancer, lymphoma, and thymoma Keep SVC syndrome on the differential for all patients with facial or upper extremity swelling References The superior vena cava syndrome: clinical characteristics and evolving etiology. Rice TW, Rodriguez RM, Light RW. Medicine (Baltimore). 2006;85(1):37. Diagnosis and management of superior vena cava syndrome. Markman M. Cleve Clin J Med. 1999;66(1):59. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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