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.
info_outline
On the Streets #11: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord
10/13/2021
On the Streets #11: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord
On this episode of On The Streets, host, Jordan Ourada sits down with neurosurgeon/neurooncologist Dr. Eddie Tsvankin to discuss various topics concerning neurosurgery and how EMS workers in the field can better understand and manage neurological emergencies. In this episode specifically, you’ll hear Jordan and Dr. Tsvankin discuss topics including: Priorities in caring for patients experiencing seizures Short and long-term complications of tumor resection surgery Specifics on how brain tumors are operated on and the difficult decisions that must be made ahead of time Assessment of post-operative incisions and signs of infections How chemotherapy and radiation effect the healing process for neurosurgery patients Dr. Eddie’s thoughts on COVID and how it has impacted his career The ins and outs of ventriculoperitoneal shunts The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20800601
info_outline
Podcast 720: Blakemore & Minnesota Tubes: Part I
10/12/2021
Podcast 720: Blakemore & Minnesota Tubes: Part I
Contributor: Dylan Luyten, MD Educational Pearls: Minnesota Tube has an extra port for suctioning otherwise is the same as a Blakemore Tube Indicated in MASSIVE upper GI bleeding often due to esophageal varices Esophageal varices are dilated, tortuous vessels in the esophagus due to increased portal venous pressure that can bleeding into the upper GI tract Patients with massive upper GI bleed should be intubated prior to placing a Blakemore/Minnesota tube References Meseeha M, Attia M. Esophageal Varices. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448078/ Biecker E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management. World J Gastroenterol. 2013;19(31):5035-5050. doi:10.3748/wjg.v19.i31.5035 Powell M, Journey JD. Sengstaken-Blakemore Tube. [Updated 2021 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20787434
info_outline
Podcast 719: Normal Saline vs. Tap Water for Wound Irrigation
10/11/2021
Podcast 719: Normal Saline vs. Tap Water for Wound Irrigation
Contributor: Ricky Dhaliwal, MD Educational Pearls: Multiple RCTs and a Cochrane Review found there is no difference in wound infection rates when irrigating with tap water Pressure of the water and how extensively the wound is irrigated were the most important factors affecting infection rates Quantity and type of water were independently not as important References Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2012;(2):CD003861. Published 2012 Feb 15. doi:10.1002/14651858.CD003861.pub3 Lewis K, Pay JL. Wound Irrigation. [Updated 2021 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538522/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20773499
info_outline
Podcast 718: Renal Failure Follow Up
10/05/2021
Podcast 718: Renal Failure Follow Up
Contributor: Aaron Lessen, MD Educational Pearls: Patients with acute renal failure often need medical management for hyperkalemia Those with severe electrolyte derangements or absent renal function may need emergent dialysis as well Dialysis catheters are 12 or 14 french catheters placed in the right internal jugular or left subclavian Placement is very similar to a central line or cordis catheter Trialysis catheter is one option that has an extra port that can be used for regular medication administration and drawing blood Do not default to use dialysis catheters for normal ED access due to risk of infection and clot development While dialysis catheters are typically reserved for dialysis only, they can be used in extreme circumstances, such as a cardiac arrest References Co I, Gunnerson K. Emergency Department Management of Acute Kidney Injury, Electrolyte Abnormalities, and Renal Replacement Therapy in the Critically Ill. Emerg Med Clin North Am. 2019;37(3):459-471. doi:10.1016/j.emc.2019.04.006 Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. [Updated 2021 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: Akaraborworn O. A review in emergency central venous catheterization. Chin J Traumatol. 2017;20(3):137-140. doi:10.1016/j.cjtee.2017.03.003 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20693054
info_outline
Podcast 717: A cautionary tale of renal failure
10/04/2021
Podcast 717: A cautionary tale of renal failure
Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia can cause EKG changes such as a widened QRS The fastest electrolyte results can be obtained off a VBG with electrolytes or point-of-care labs Hyperkalemia may be reported as “hemolyzed” which indicated lysis of red blood cells and artificial elevation of the potassium level. However, always keep in mind the clinical context and look at other metabolic abnormalities like creatinine and BUN for other clues that it may actually not be hemolyzed References Co I, Gunnerson K. Emergency Department Management of Acute Kidney Injury, Electrolyte Abnormalities, and Renal Replacement Therapy in the Critically Ill. Emerg Med Clin North Am. 2019;37(3):459-471. doi:10.1016/j.emc.2019.04.006 Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. [Updated 2021 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470284/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20693039
info_outline
Podcast 716: Resuscitation Fluids
09/29/2021
Podcast 716: Resuscitation Fluids
Contributor: Nick Tsipis, MD Educational Pearls: Fluid choice may have an impact on outcomes in resuscitation, and a meta-analysis has relevant insight into their use in sepsis and trauma patients Large volume normal saline fluid resuscitation in sepsis is associated with acute kidney injury and metabolic acidosis compared to Lactated Ringers Choice of fluid did not have significant differences in trauma patients for initial resuscitation References Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu YK. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses. Crit Care. 2020;24(1):693. Published 2020 Dec 14. doi:10.1186/s13054-020-03419-y The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20627156
info_outline
Podcast 715: Heated High Flow O2
09/27/2021
Podcast 715: Heated High Flow O2
Contributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or “heated high flow” can deliver higher oxygen levels than nasal cannula It typically is used as an “intermediate” between oxygen via nasal cannula and other non-invasive positive pressure devices, such as BiPAP Can modify both the FiO2 and flow rate Maximum flow rate is typically 60 liters per minute (compare that to a typical breath that is 30-40 L/min) Humidification of HFNC is important due to risk of epistaxis from drying out the nasal mucosa Large energy expenditure to humidify airflow by a patient in respiratory distress, so humidified oxygen may help decrease this metabolic demand References Nishimura M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respir Care. 2016;61(4):529-541. doi:10.4187/respcare.04577 Hacquin A, Perret M, Manckoundia P, et al. High-Flow Nasal Cannula Oxygenation in Older Patients with SARS-CoV-2-Related Acute Respiratory Failure. J Clin Med. 2021;10(16):3515. Published 2021 Aug 10. doi:10.3390/jcm10163515 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20608535
info_outline
Podcast 714: Intradermal Sterile Water for Back Pain
09/21/2021
Podcast 714: Intradermal Sterile Water for Back Pain
Contributor: Aaron Lessen, MD Educational Pearls: Randomized controlled-trial evaluated intradermal injections of sterile water to manage low back pain versus an IV NSAID Four intradermal injections of 0.1 cc sterile water in a square around the area of musculoskeletal pain Reduction of pain was 7 points with the procedure and 2 points with the IV NSAID at 24 hours 12% in the injection group versus 50% in the IV NSAID group needed opioids 87% patient satisfaction in the injection group versus 16% patient satisfaction in the IV NSAID group References Tekin E, Gur A, Bayraktar M, Ozlu I, Celik BK. The effectiveness of intradermal sterile water injection for low back pain in the emergency department: A prospective, randomized controlled study. Am J Emerg Med. 2021;42:103-109. doi:10.1016/j.ajem.2021.01.038 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20545427
info_outline
Podcast 713: Oral Ketamine
09/20/2021
Podcast 713: Oral Ketamine
Contributor: Don Stader, MD Educational Pearls: Those on chronic opioid therapy may have high tolerance to opioids and/or opioid hyperalgesia Ketamine is a good adjunct for pain control in patients on chronic opioid therapy To avoid the time constraints often required to push ketamine intravenously, it can be given orally: Ketamine IV 25-50 mg (~0.01-0.03 mg/kg) as a single dose by mouth References Blonk M, Koder B, et al. Use of oral ketamine in chronic pain management: A review. European Journal of Pain. 2009. Schwenk ES, et al. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the America Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20524088
info_outline
Podcast 712: Cephalosporin with a Penicillin Allergy
09/13/2021
Podcast 712: Cephalosporin with a Penicillin Allergy
Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study in the Kaiser system looked at over 4 million patients receiving antibiotics to determine the effect of penicillin allergy prompts in the EHR on antibiotic prescribing Half of the sites removed prompts stating penicillin allergy and half kept the prompts Patients with penicillin allergies who received cephalosporins went up from 20% to 27% in areas where the prompt was remove No difference in mortality or no new allergies found between the two groups Reduced the use of fluoroquinolones and clindamycin in the group without the prompt References Macy E, McCormick TA, Adams JL, et al. Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing. JAMA Netw Open. 2021;4(4):e218367. Published 2021 Apr 1. doi:10.1001/jamanetworkopen.2021.8367 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20455256
info_outline
On the Streets #10: IO Administration Gone Awry
09/08/2021
On the Streets #10: IO Administration Gone Awry
Dr. Glenda Quan, trauma surgeon from Swedish Medical Center joins our host Jordan Ourada to review a case of an incorrectly placed IO and how to avoid it. The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20403257
info_outline
Podcast 711: Insulin Pumps
09/07/2021
Podcast 711: Insulin Pumps
Contributor: Aaron Lessen, MD Educational Pearls: Insulin pumps provide a continuous infusion of fast-acting insulin using a basal rate and bolus prior to meals Some connect to a continuous glucometer but often blood glucose needs to be checked manually Hypoglycemia is rarely due to a malfunctioning pump - there is usually an another external factor Hyperglycemia can be caused by underdosing, illness, pump malfunction or expired insulin The pump can be used to give a bolus of insulin in the emergency department if necessary Stopping the device can be done manually on the device or disconnecting it from the tubing attachment - do not remove the tubing from the skin site if possible References Nimri R, Nir J, Phillip M. Insulin Pump Therapy. Am J Ther. 2020;27(1):e30-e41. doi:10.1097/MJT.0000000000001097 Sora ND, Shashpal F, Bond EA, Jenkins AJ. Insulin Pumps: Review of Technological Advancement in Diabetes Management. Am J Med Sci. 2019;358(5):326-331. doi:10.1016/j.amjms.2019.08.008 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20388299
info_outline
Podcast 710: Droperidol vs. Zyprexa
08/31/2021
Podcast 710: Droperidol vs. Zyprexa
Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about 16 minutes for both agents Droperidol was slightly less sedating than olanzapine and length of stay for olanzapine was longer Olanzapine had a higher rate of requiring another agent for adequate sedation Droperidol had a higher rate of adverse events (mainly extrapyramidal symptoms) than olanzapine Remember to put the safety of the staff and patient at the forefront of sedation practices and be cognizant of the psychological effect of giving involuntary medications to patients References Cole JB, Stang JL, DeVries PA, Martel ML, Miner JR, Driver BE. A Prospective Study of Intramuscular Droperidol or Olanzapine for Acute Agitation in the Emergency Department: A Natural Experiment Owing to Drug Shortages. Ann Emerg Med. 2021;78(2):274-286. doi:10.1016/j.annemergmed.2021.01.005 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20304011
info_outline
Podcast 709: Clown Therapy
08/30/2021
Podcast 709: Clown Therapy
Contributor: Jared Scott, MD Educational Pearls: Using LET, procedural sedation, and distraction techniques are often needed to successfully perform painful procedures in pediatrics patients The technique of clown therapy has been studied as an adjunct to LET and other distraction techniques for procedures in pediatric patients One randomized-controlled trial from 2016 found anxiety was greatly reduced using medical clown therapy to aid in painful procedures in pediatrics patients References Felluga M, Rabach I, Minute M, et al. A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department. Eur J Pediatr. 2016;175(5):645-650. doi:10.1007/s00431-015-2688-0 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20303996
info_outline
Podcast 708: Diagnostic Paracentesis
08/24/2021
Podcast 708: Diagnostic Paracentesis
Contributor: Peter Bakes, MD Educational Pearls: Paracentesis is a procedure where fluid is removed from the peritoneal cavity by needle Indications for paracentesis include: large volume paracentesis (5-6L), diagnosis of transudative or exudative ascites, evaluation for spontaneous bacterial peritonitis (SBP) Infection of ascitic fluid is more likely in transudative processes due to the increased frequency of paracentesis E coli is the most common pathogen to cause SBP Treatment with 3rd generation cephalosporin, like ceftriaxone References Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
/episode/index/show/emergencymedicalminute/id/20241182
info_outline
Podcast 707: Sigmoid Volvulus
08/23/2021
Podcast 707: Sigmoid Volvulus
Contributor: Aaron Lessen, MD Educational Pearls: Sigmoid volvulus occurs when the sigmoid colon twists 180 to 360 degrees 10% of intestinal obstructions in the US; 50-70% of intestinal obstructions worldwide More common in elderly patients with chronic constipation Eventually may lead to bowel perforation, a surgical emergency Treatment is sigmoidoscopy or sigmoid colectomy References Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20225378
info_outline
Podcast 706: Pepper Spray Decon
08/18/2021
Podcast 706: Pepper Spray Decon
Contributor: Ramnik Dhaliwal, MD JD Educational Pearls: Pepper spray is a highly irritating compound with active ingredient of capsaicin Techniques to help decontaminate and alleviate symptoms of an exposure include: Disrobing the patient to prevent further exposure Half milk of magnesia and half water mixture can be used to soothe the skin in the area of exposure Proparacaine followed by Morgan lens to irrigate the eye in adults Nasal cannula connected to a liter of normal saline can passively irrigate the eye in small children and other less than cooperating patients References Tidwell RD, Wills BK. Tear Gas and Pepper Spray Toxicity. [Updated 2020 Nov 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544263/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
/episode/index/show/emergencymedicalminute/id/20179403
info_outline
Podcast 705: Pyloric Stenosis
08/17/2021
Podcast 705: Pyloric Stenosis
Contributor: Neil Cella, MD Educational Pearls: Pylorus becomes hypertrophied and does not allow food or liquid to pass through to the duodenum tOccurs between the ages of 3 weeks to 3 months Classic presentation includes projectile nonbilious vomiting and palpable abdominal mass Ultrasound can visualize/diagnose pyloric stenosis and the treatment is surgical correction Be aware that electrolyte abnormalities and acid/base disturbances may occur References Garfield K, Sergent SR. Pyloric Stenosis. [Updated 2021 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555931/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
/episode/index/show/emergencymedicalminute/id/20167250
info_outline
Podcast 704: Treatment of Pneumothorax
08/16/2021
Podcast 704: Treatment of Pneumothorax
Contributor: Adam Barkin, MD Educational Pearls: Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up 316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms 15% of the conservative group required further intervention as determined by prespecified protocols 94.4% of the intervention group had resolution at 8 weeks, whereas 98.5% of the conservative group had resolution at 8 weeks These data were affected by poor follow up CXR resolution average of 16 days in the intervention group and 30 days in the conservative group Symptom resolution was similar between the two groups (median 15 days vs. 14 days) Recurrence at 12 months was 17% in interventional group vs 8% in conservative group 41 adverse events in intervention group and 13 adverse events in conservative group References Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415. doi:10.1056/NEJMoa1910775 Franzen, D. (2019, November). Pneumothorax. Society of Academic Emergency Medicine. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-respiratory/pneumothorax. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20152769
info_outline
Mental Health Monthly #8: Trauma-Informed Care
08/11/2021
Mental Health Monthly #8: Trauma-Informed Care
Contributor: Randi Libbon, MD The Core features of trauma-informed care include: Patient empowerment, choice and collaboration. This means educating patients and allowing patients to make choices about their care when possible. Collaboration helps to level the power differential between patients and providers through shared decision making. Safety and sensitivity: Developing health care settings and activities that ensure patients’ physical and emotional safety taking into account their diverse backgrounds of gender, sexuality, race, culture, and ethnicity Trustworthiness and transparency: Creating clear expectations with patients about what proposed treatments entail, who will provide services, and how care will be provided. Resources: Reeves E. A synthesis of the literature on trauma-informed care. Issues Ment Health Nurs. 2015;36(9):698-709. doi: 10.3109/01612840.2015.1025319. PMID: 26440873. Molloy L, Fields L, Trostian B, Kinghorn G. Trauma-informed care for people presenting to the emergency department with mental health issues. Emerg Nurse. 2020 Mar 10;28(2):30-35. doi: 10.7748/en.2020.e1990. Epub 2020 Feb 25. PMID: 32096370. Key ingredients for Trauma-informed care from SAMHSA The National Childhood Traumatic Stress Network: The Science of Adverse Childhood Events and Toxic Stress: From the Institute for Health Care Improvement:
/episode/index/show/emergencymedicalminute/id/20101424
info_outline
Podcast 703: Fever in Infants
08/10/2021
Podcast 703: Fever in Infants
Contributor: Neil Cella, MD Educational Pearls: <29 day old well-appearing febrile infant: 10% of patients <29 days old with a fever (>100.4) have an serious bacterial infection Most of these are UTIs, but also consider pneumonia and meningitis Requires CXR, LP, labs, and UA to work up cause of fever 29-60 day old well-appearing febrile infant: Can discharge without abx if CXR, lumbar puncture, labs and UA without signs of bacterial infection If UA is positive for UTI a LP is still indicated for febrile infants <29 days old, but may not be required for febrile infants 29-60 days old References Hamilton JL, Evans SG, Bakshi M. Management of Fever in Infants and Young Children. Am Fam Physician. 2020;101(12):721-729. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
/episode/index/show/emergencymedicalminute/id/20092739
info_outline
Podcast 702: Paralytic Awareness
08/09/2021
Podcast 702: Paralytic Awareness
Contributor: Aaron Lessen, MD Educational Pearls: Known risk factors for being awake and paralyzed in the OR include only receiving IV medications, long-acting paralytics, and no formal monitoring system for being awake The ED-AWARENESS study, a prospective single-center study found 2.6% of patients with induced paralysis during mechanical ventilation were aware Rocuronium was a risk factor for developing awareness while paralyzed in this study Ensure adequate sedation during paralysis for mechanical ventilation in the ED setting, especially when using rocuronium References Pappal RD, Roberts BW, Mohr NM, et al. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532-544. doi:10.1016/j.annemergmed.2020.10.012 Pappal RD, Roberts BW, Winkler W, Yaegar LH, Stephens RJ, Fuller BM. Awareness With Paralysis in Mechanically Ventilated Patients in the Emergency Department and ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2021;49(3):e304-e314. doi:10.1097/CCM.0000000000004824 The Emergency Medical Minute offers AMA PRA Category 1 credits™ via online course modules. For more information and to access this content,, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20029736
info_outline
Podcast 701: Elevated Blood Pressure Readings
08/03/2021
Podcast 701: Elevated Blood Pressure Readings
Contributor: Aaron Lessen, MD Educational Pearls: Recent retrospective cohort study looked at elevated BP readings in the ED and correlation to underlying hypertension Large cohort of over 30,000 patients found that nearly 50% had an elevated blood pressure reading in the ED Less than 15% of patients with elevated BP readings in the ED were diagnosed with hypertension within 2 years Only 25% of patients with BP readings >160/100 were diagnosed with hypertension within 2 years Patients with an elevated blood pressure reading of >160/100 had only a slightly increased risk of stroke, transient ischemic attack, acute coronary syndrome, heart failure, or death in the next 2 years References McAlister FA, Youngson E, Rowe BH. Elevated Blood Pressures Are Common in the Emergency Department but Are They Important? A Retrospective Cohort Study of 30,278 Adults. Ann Emerg Med. 2021;77(4):425-432. doi:10.1016/j.annemergmed.2020.11.005 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute offers AMA PRA Category 1 credits™ via online course modules. For more information and to access this content,, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20009297
info_outline
Podcast 700: Analgesics for Acute Musculoskeletal Pain
08/02/2021
Podcast 700: Analgesics for Acute Musculoskeletal Pain
Contributor: Aaron Lessen, MD Educational Pearls: Recent RCT compared pain relief in patients receiving five medications for acute musculoskeletal pain Acetaminophen 1000mg/ibuprofen 400 mg Acetaminophen 1000mg/ibuprofen 800 mg Acetaminophen 300 mg/codeine 30 mg Acetaminophen 300mg/hydrocodone 5mg Acetaminophen 325mg/oxycodone 5mg No significant difference in pain relief at 1 and 2 hours between all of 5 groups References Bijur PE, Friedman BW, Irizarry E, Chang AK, Gallagher EJ. A Randomized Trial Comparing the Efficacy of Five Oral Analgesics for Treatment of Acute Musculoskeletal Extremity Pain in the Emergency Department. Ann Emerg Med. 2021;77(3):345-356. doi:10.1016/j.annemergmed.2020.10.004 The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/20002277
info_outline
Podcast 699: Pediatric Fingernail Avulsions
07/28/2021
Podcast 699: Pediatric Fingernail Avulsions
Contributor: Aaron Lessen, MD Educational Pearls: Traditionally, fingernails were replaced after avulsion using sutures Sometimes artificial material was placed when the fingernail was not available Recent study evaluated treatment of fingernail avulsions pediatric patients by replacing the nail versus cleaning and putting a non-adhesive dressing No difference in the aesthetics or patient satisfaction with the new fingernail between the two treatment groups References Seiler M, Gerstenberg A, Kalisch M, Kennedy U, Scheer HS, Weber DM. Non-operative treatment versus suture refixation of the nail plate in paediatric fingernail avulsion injuries. J Hand Surg Eur Vol. 2021;46(5):523-529. doi:10.1177/1753193420965390 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/19956914
info_outline
Podcast 698: Empathy, Burnout, and Patient Satisfaction
07/27/2021
Podcast 698: Empathy, Burnout, and Patient Satisfaction
Contributor: Aaron Lessen, MD Educational Pearls: Survey of EM physicians to self-report empathy and burnout levels and correlated with patient satisfaction scores Patient satisfaction was not affected by what the physicians thought about their level of empathy or burnout Patient satisfaction was affected by the patient’s perception of empathetic behavior by the physician References Byrd J, Knowles H, Moore S, et al. Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study [published online ahead of print, 2020 Nov 25]. Emerg Med J. 2020;emermed-2019-209393. doi:10.1136/emermed-2019-209393 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/19942196
info_outline
Podcast 697: Kounis Syndrome
07/26/2021
Podcast 697: Kounis Syndrome
Contributor: Aaron Lessen, MD Educational Pearls: Kounis syndrome is an allergic acute coronary syndrome Triggers include medications (antibiotics), insect bites, or other common allergens Believed to be due to mast cell activation, inflammatory cytokines, and platelet activation causing coronary vasospasm or plaque rupture in setting of existing atherosclerosis Consider Kounis syndrome in the setting of chest pain in anaphylaxis Treatment involves treatment of allergic reaction, although epinephrine should be used cautiously Avoid morphine as this can cause mast cell activation References The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/19928525
info_outline
Podcast 696: ST Elevation and Differential Diagnoses
07/21/2021
Podcast 696: ST Elevation and Differential Diagnoses
Contributor: Peter Bakes, MD Educational Pearls: ST elevation clinical guidelines for myocardial infarction include: 2.5 mm elevation for males <40 in V2 and V3 2 mm elevation in males >40 in V2 and V3 1.5 mm elevation for females in V2 and V3 1 mm elevation in 2 or more contiguous leads (not V2 or V3) Differential diagnosis of ST elevation includes, but is not limited to: STEMI Electrolyte abnormalities Pericarditis/myocarditis Brugada syndrome LVH Bundle branch blocks Ventricular aneurysm References de Bliek EC. ST elevation: Differential diagnosis and caveats. A comprehensive review to help distinguish ST elevation myocardial infarction from nonischemic etiologies of ST elevation. Turk J Emerg Med. 2018;18(1):1-10. Published 2018 Feb 17. doi:10.1016/j.tjem.2018.01.008 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/19878062
info_outline
Podcast 695: Einstein and Cellophane
07/20/2021
Podcast 695: Einstein and Cellophane
Educational Pearls: Albert Einstein had chronic abdominal pain as a middle-aged man Dr. Rudolph Nissen, founder of the Nissen fundoplication, performed exploratory surgery for this pain and found an abdominal aortic aneurysm (AAA) The only treatment for an AAA at that time was to wrap the vessel in cellophane, causing a fibrotic response to prevent rupture Einstein died 7 years after this surgery, likely from his leaking abdominal aortic aneurysm References Cervantes Castro J. Albert Einstein y su aneurisma de la aorta [Albert Einstein and his abdominal aortic aneurysm]. Gac Med Mex. 2011;147(1):74-76. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/19865822
info_outline
Podcast 694: Complete Heart Block
07/19/2021
Podcast 694: Complete Heart Block
Contributor: Nick Hatch, MD Educational Pearls: Complete heart block or 3rd degree atrioventricular (AV) block is diagnosed via EKG and occurs when electrical signals from the sinoatrial (SA) node are blocked from reaching the ventricles via the AV node and AV bundles P waves and QRS complexes are independent Often QRS rate is around 40 The rate is slow because the ventricular purkinje fibers have an intrinsic rate of 20-40 bpm, whereas the SA node has an intrinsic rate of 60-100 bpm Treatment is usually with pacemaker, unless there is an identifiable etiology causing the heart block that can be reversed References Knabben V, Chhabra L, Slane M. Third-Degree Atrioventricular Block. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at and create an account.
/episode/index/show/emergencymedicalminute/id/19852418