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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Podcast 585: You Sure You Want Colchicine for Gout?
08/10/2020
Podcast 585: You Sure You Want Colchicine for Gout?
Contributor: Don Stader, MD Educational Pearls: Gout is an arthritis caused by the deposition of urate crystals into the joint space Colchicine works by disrupting microtubules and prevents white blood cells from getting into the joint space which stops the inflammatory response Colchicine has a high rate of adverse events, in particular explosive diarrhea The drug also has a very narrow therapeutic index and overdose is nearly universally fatal, with no antidote or effective treatment option available Alternative agents such as steroids, which reduce the inflammatory response to urate crystals, along with NSAIDs may be better options for treatment References Angelidis C, Kotsialou Z, Kossyvakis C, et al. . Curr Pharm Des. 2018;24(6):659-663. doi:10.2174/1381612824666180123110042 Finkelstein Y, Aks SE, Hutson JR, et al. 2010;48(5):407-414. doi:10.3109/15563650.2010.495348 Dalbeth N, Merriman TR, Stamp LK. Lancet. 2016;388(10055):2039-2052. doi:10.1016/S0140-6736(16)00346-9 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 584: Ketamine for Depression and Suicidality
08/04/2020
Podcast 584: Ketamine for Depression and Suicidality
Contributor: Jared Scott, MD Educational Pearls: Suicide is currently the 10th leading cause of death in the US Low quality studies have reported ketamine as a potential promising agent in treating depression and preventing suicidal ideations or thoughts Randomized study was performed looking at giving ketamine to depressed patients in the ED to see if they could establish a proof of concept, meaning: would looking at ketamine for treatment of acute depression or suicidality be viable? 18 suicidal patients who required hospitalization for their depression and suicidality were entered in the study. 88% of the group treated with ketamine felt like their symptoms improved for up to 3 days, while only 33% of the placebo group reported an improvement References Domany Y, Shelton RC, McCullumsmith CB. Depression & Anxiety (1091-4269). 2020;37(3):224-233. doi:10.1002/da.22975. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 583: Raise Your Hands if You Have Carpal Tunnel Syndrome
08/03/2020
Podcast 583: Raise Your Hands if You Have Carpal Tunnel Syndrome
Contributor: Aaron Lessen, MD Educational Pearls: Hand raising test: a simple but effective tool to diagnose carpal tunnel Patients hold their hands over their head and if symptoms of carpal tunnel develop within 2 minutes, it is considered positive, meaning they likely have carpel tunnel Symptom included numbness and dull pain in the distribution of the median nerve Treatment for carpal tunnel in the ED can include splinting in a neutral position and oral steroids with possible follow up for steroid injections or surgery References Padua L, Coraci D, Erra C, et al. Lancet Neurol. 2016;15(12):1273-1284. doi:10.1016/S1474-4422(16)30231-9 Ma H, Kim I. . J Korean Neurosurg Soc. 2012;52(5):472-475. doi:10.3340/jkns.2012.52.5.472 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Rapid Fire Pharmacy Review with Adis Keric of ER-Rx
07/29/2020
Rapid Fire Pharmacy Review with Adis Keric of ER-Rx
Meet Adis Keric, Board Certified Pharmacotherapy Specialist and a Board Certified Critical Care pharmacist who works in the Emergency Department and ICU of level 1 trauma center Regions Hospital in Saint Paul, MN. Adis is the founder and host of a new FOAMed podcast, ER-Rx. He started the podcast to inform clinicians in the ED and ICU about up-to-date, appropriate and optimal use of medications in different clinical scenarios. Dr. Nick Tsipis sits down with Adis to discuss some pearls in Emergency Medicine Pharmacy. Time Stamps: 0:10 Intros 4:35 Antibiotics 8:30 Post-Intubation Sedation 12:00 Anti-coagulation reversal* 16:00 ER-Rx Plug *Correction to figures quoted on anticoagulation reversal pricing. High-dose Andexxa regimen maxes out around $60,000 and Kcentra maxes out at $6,000. So there is still a massive price difference, but not as high as quoted in the audio. Check out ER-Rx on iTunes, Google Podcasts, Spotify, YouTube and other major podcast hosting platforms! Instagram: @errxpodcast Website:
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Podcast 582: Gadolinium - The Contrast of MRI
07/28/2020
Podcast 582: Gadolinium - The Contrast of MRI
Contributor: Michael Hunt, MD Educational Pearls: Contrast agents are commonly used for X-rays and CT’s to better characterize disease, but contrast doesn’t work with MRI. That’s where the element Gadolinium comes into play. Gadolinium, element 64, is ferromagnetic (attracted to iron) below 68 degrees and above that temperature it’s paramagnetic which makes it useful in MRI (Magnetic Resonance Imaging). Gadolinium is toxic alone, but when paired with chelators it can be used in humans and allows for better characterization of tumors or abnormal tissue on MRI. It helps identify this abnormal tissue because when MRI causes polarization of our body’s cells, the gadolinium, which has the maximum number of unpaired electrons in its orbital shells, alters the rate of decay in abnormal tissue highlighting abnormalities on imaging. Gadolinium can also be used in the treatment of cancers because it collects in the cells of abnormal tissue, allowing for more targeted therapies. In people exposed to gadolinium, the anaphylaxis rate is low, below 1/1000, and in rare cases there are reports of kidney injury and nephrogenic systemic fibrosis which is why it’s not recommended in renal failure patients. References Ibrahim MA, Hazhirkarzar B, Dublin AB. Magnetic Resonance Imaging (MRI) Gadolinium. [Updated 2020 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: Pasquini L, Napolitano A, Visconti E, et al. Gadolinium-Based Contrast Agent-Related Toxicities [published correction appears in CNS Drugs. 2018 May 15;:]. CNS Drugs. 2018;32(3):229-240. doi:10.1007/s40263-018-0500-1 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 581: Alcohol Complications
07/27/2020
Podcast 581: Alcohol Complications
\Contributor: Don Stader, MD Educational Pearls: Altered mental status/confusion are major symptoms associated with both alcohol use and withdrawal. Wernicke’s encephalopathy is a triad of symptoms of confusion, internuclear ophthalmoplegia, and confabulation The treatment for Wernicke’s is IV thiamine or vitamin B1 Untreated Wernicke’s leads to Korsakoff's syndrome where a prolonged thiamine deficiency leads to worsening brain function Subdural hematomas from torn bridging veins are common in alcoholics because of the combination of frequent falls and cerebral atrophy caused by alcohol. Alcohol is a major cause of heart failure and atrial fibrillation; “holiday heart” is a-fib induced by binge drinking where high levels of acetaldehyde from the metabolism of alcohol excite the heart. Frequent alcohol use is linked to esophageal cancer Alcoholic cirrhosis can lead to a multitude of complications including esophageal varices that can rupture often with fatal outcomes Aspiration pneumonia is more common in alcoholics because of a depressed gag reflex and alteration of oral flora References Brousse G, Geneste-Saelens J, Cabe J, Cottencin O. Alcool et urgences [Alcohol and emergencies]. Presse Med. 2018;47(7-8 Pt 1):667-676. doi:10.1016/j.lpm.2018.06.001 Chandrakumar A, Bhardwaj A, 't Jong GW. Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis. J Basic Clin Physiol Pharmacol. 2018;30(2):153-162. Published 2018 Oct 2. doi:10.1515/jbcpp-2018-0075 Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open. 2018;8(8):e022344. Published 2018 Aug 22. doi:10.1136/bmjopen-2018-022344 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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On The Streets #6: Artificial Intelligence Detection for LVOs
07/22/2020
On The Streets #6: Artificial Intelligence Detection for LVOs
Meet Michelle Whaley, Clinical Nurse Specialist and Stroke Program Coordinator at Sky Ridge Medical Center in Lone Tree, Colorado. Jordan and Michelle discuss advances in Artificial Intelligence technology in an app that uses algorithms to analyze CT Angiograms to alert physicians of patients with images concerning for Large Vessel Occlusions (LVOs). Listen as they discuss the sweeping implications of this technology in the realm of stroke care and how it is decreasing wait times for critical patients to receive tPA and interventional procedures. For EMS, this technology is already improving the care given by specialized transfer teams of patients from smaller hospitals to regional stroke centers. Tune in for other applications of this technology in pre-hospital settings on the horizon. Disclaimer: This episode of On The Streets is for educational purposes only. Emergency Medical Minute is not affiliated with VIZ AI in any way and did not receive compensation for this episode.
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Podcast 580: Origin of PPE
07/21/2020
Podcast 580: Origin of PPE
Contributor: Michael Hunt, MD Educational Pearls: PPE, or personal protective equipment, has become a major talking point since the emergence of the novel coronavirus (COVID 19). While ubiquitous now, there was not always equipment to protect health care providers or patients from infectious exposures. The invention of surgical gloves are credited to surgeon William Halsted. He developed gloves because one of his assistants (and later wife), Carol Hampton, was having severe irritation due to a caustic pre-op disinfecting process. They developed the rubber glove for Hampton which garnered popularity, and by the early 20th century, half of surgeons were using rubber gloves. Surgical masks came around during the same period as gloves. By 1919 about half of all surgeons were using masks, protecting themselves and their patients from infectious transmissions. The simple advent of masks and gloves led to incredible reductions in morbidity and mortality in surgical cases. Now these simple barriers are key in the prevention of further transmitting of COVID-19. References . Kean, Sam. “Glove at First Sight.” podbean.com, 27 Apr. 2020, disappearingspoon.podbean.com/e/glove-at-first-sight/. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 579: Yersinia Pestis
07/20/2020
Podcast 579: Yersinia Pestis
Contributor: Don Stader, MD Educational Pearls: Yersinia Pestis is the bacteria that caused the black plague. It was first discovered to be the cause of the bubonic plague in 1800s in China during the 3rd bubonic plague where 10-20 million people died Causes 3 types of plague: Bubonic plague: characterized by severe swelling of lymph nodes called buboes, most commonly in the groin, also axillary and olecranon lymph nodes. Septicemic plague: characterized by severe sepsis, no lymphadenopathy. This strain famously causes disseminated intravascular coagulopathy (DIC) and can lead to limb necrosis and fingers turning black. Hence the name the Black Death. Pneumonic: most dangerous of the plagues and characterized by PNA on CXR with pronounced mediastinal lymphadenopathy Fleas are the largest reservoir, although prairie dogs and squirrels have been known to carry the bacteria as well. Yersinia Pestis creates a microfilm inside the stomach of fleas and renders them incapable of digesting your blood when they try to eat it and they vomit the bacteria into your blood. Doxycycline and Ciprofloxacin are the mainstay of treatment. References Achtman M, Zurth K, Morelli G, Torrea G, Guiyoule A. Carniel E. Yersinia pestis, the cause of plague, is a recently emerged clone of Yersinia pseudotuberculosis. Proc Natl Acad Sci U S A. 1999. doi:10.1073/pnas.96.24.14043 Galimand M, Carniel E, Courvalin P. Resistance of Yersinia pestis to Antimicrobial Agents. Antimicrob Agents Chemother. 2006;50(10):3233 LP - 3236. doi:10.1128/AAC.00306-06 Sexton D, Stout J. Clinical Manifestations, Diagnosis, And Treatment Of Plague (Yersinia Pestis Infection). Waltham, MA: UpToDate; 2020. Summarized by Mason Tuttle & Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 578: Brown-Sequard Syndrome
07/14/2020
Podcast 578: Brown-Sequard Syndrome
Author: Eric Miller, MD Educational Pearls: Brown-Sequard Syndrome is a neurological deficit that results from hemisection of the spinal cord This is usually from traumatic injury (blunt or penetrating), but can rarely be seen with cancer, disc herniation, or infection It presents with flaccid paralysis and loss of sensation to touch/vibration/position on the same side as the injury with loss of pain/temperature sensation on the opposite side of the injury. These deficits will be below the level of injury. References Roth, E., Park, T., Pang, T. et al. Traumatic cervical Brown-Sequard and Brown-Sequard-plus syndromes: the spectrum of presentations and outcomes. Spinal Cord 29, 582–589 (1991). Wagner R, Jagoda A. Spinal cord syndromes. Emerg Med Clin North Am. 1997;15(3):699. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 577: Immunotherapies
07/13/2020
Podcast 577: Immunotherapies
Contributor: Don Stader, MD Educational Pearls: Checkpoint inhibition normally helps our body detect abnormal cells and terminate it but cancerous cells often are able to avoid this countermeasure Monoclonal antibodies that bind to checkpoint inhibitors can stop cancerous cells from turning off immunologic T cells and allows the immune system to continue to attack cancers. These therapies carry risks of exacerbating autoimmune problems due to the ramped up immune response Most often this autoimmune attack leads to skin and GI symptoms but can affect many other organ systems. In the emergency room this can present many different ways, but the mainstay of treatment is steroids to stop these exacerbations. Chimeric Antigen Receptor (CAR) T-cell Therapy is another immunotherapy where antigens to a cancerous cell are re-introduced to spur a directed immune response Cytokine release syndrome can occur in these patients and mimic other presentations such as septic shock, a result of tumor break down This is treated with steroids and monoclonal antibodies that help thwart the cytokine release References Hay, KA. Cytokine release syndrome and neurotoxicity after CD19 chimeric antigen receptor-modified (CAR-) T cell therapy. Br J Haematol. 2018 Nov;183(3):364-374. doi: 10.1111/bjh.15644. Epub 2018 Nov 8. Hryniewicki AT, Wang C, Shatsky RA, Coyne CJ. Management of Immune Checkpoint Inhibitor Toxicities: A Review and Clinical Guideline for Emergency Physicians. J Emerg Med. 2018;55(4):489-502. doi:10.1016/j.jemermed.2018.07.005 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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UnfilterED #9: Dr. Steven Bradley
07/08/2020
UnfilterED #9: Dr. Steven Bradley
Dr. Steven Bradley is an active duty U.S. Naval officer practicing as a Staff Anesthesiologist in Virginia where also resides on the Medical Ethics Committee for his hospital. He serves as the Anesthesiology Residency Simulation Coordinator there and enjoys the opportunity to teach residents drawing from his experiences as a student. He just recently started The Black Doctors Podcast where he strives to tell stories of Black physicians who overcame adversity to attain their goals so that young individuals in the minority can listen and learn. Tune in to hear Dr. Bradley discuss his experience as a minority in medicine and how systemic racism can manifest in various aspects of medicine. Check out The Black Doctors Podcast on , , and all major streaming platforms. Instagram: @theblackdoctorspodcast Twitter: @StevenBradleyMD
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Podcast 576: Status Epilepticus Drugs
07/07/2020
Podcast 576: Status Epilepticus Drugs
Author: Charlene Gnisci Melton, PharmD Educational Pearls: Status Epilepticus is defined as continuous seizure activity for >5 minutes, or 2 or more seizures without full return to consciousness between events Status epilepticus is a true neurologic emergency with significant morbidity and mortality Aggressive, early treatment of status epilepticus is essential as GABA receptors will regress over time and make benzodiazepines less effective as time elapses Go large with doses of benzodiazepines and repeat doses if necessary: In adults this means lorazepam 4 mg IV push or Midazolam 10 mg intramuscular if no IV access Second line agents include: Levetiracetam (Keppra) 60 mg/kg up to 4500mg Valproic Acid (40 mg/kg up to 3000 mg) Keppra has an arguably better side effect profile and compatibility compared to other second-line agents Third line agents include intubation and sedation with propofol, benzodiazepines, or even ketamine Editor’s note: from a time management perspective, call for your second-line treatment early to get it from pharmacy while you slam the benzodiazepines, then it will be arriving hopefully when you need it, and no harm if you don’t. Oh, and don’t forget a fingerstick glucose. References Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61. doi:10.5698/1535-7597-16.1.48 Walker, M.C. Pathophysiology of status epilepticus. Neuroscience Letters. 2018:667:84-91. https://doi.org/10.1016/j.neulet.2016.12.044 Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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Epidemic Meets Pandemic #4: The Patient Perspective
07/06/2020
Epidemic Meets Pandemic #4: The Patient Perspective
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In the final episode of this series, we are fortunate enough to speak with Chris Espinoza and Ashley Parsons, two individuals currently in recovery. Chris and Ashley bravely share the origins of their substance use disorders, the challenges that COVID has presented during their recovery process as well as their current life goals and hopes for the future. ______________________________________ Illustration by Kelly Caminero/The Daily Beast/Shutterstock
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Podcast 575: Light on the Sedation
07/06/2020
Podcast 575: Light on the Sedation
Contributor: Aaron Lessen, MD Educational Pearls: Studies have shown that patients who are under deeper sedation in the ICU have worse outcomes. Recent study compared lighter vs heavier sedation of patients in the emergency department receiving mechanical ventilation Patients receiving lighter sedation in the ED were often continued in the ICU Patients who had lighter sedation also tended to do better, meaning less days on the ventilator, less days in the ICU, and lower mortality supporting prior observations. Though purely observational, interesting suggestion that lighter sedation starting in the emergency department could have significant impact on important clinical outcomes References Fuller BM, Roberts BW, Mohr NM, et al. The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients. Crit Care Med. 2019;47(11):1539‐1548. doi:10.1097/CCM.0000000000003928 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Epidemic Meets Pandemic #3: The Law Enforcement Perspective
07/01/2020
Epidemic Meets Pandemic #3: The Law Enforcement Perspective
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In this episode, we speak with Lex Jorge -- a Denver Police Narcotics Sergeant -- to gain insight into how drug trafficking has been impacted by COVID. We also discuss law enforcement’s role in the recovery process and touch on social issues currently afflicting the country. ______________________________________ Illustration by Kelly Caminero/The Daily Beast/Shutterstock
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Epidemic Meets Pandemic #2: The Addiction Medicine Perspective
06/30/2020
Epidemic Meets Pandemic #2: The Addiction Medicine Perspective
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In this episode, we talk to Dr. Steven Young -- board certified emergency physician and addiction medicine physician -- to discover how his clinic has had to adapt and overcome the challenges presented by COVID. Resources: ______________________________________ Illustration by Kelly Caminero/The Daily Beast/Shutterstock
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Epidemic Meets Pandemic #1: The Harm Reductionist Perspective
06/29/2020
Epidemic Meets Pandemic #1: The Harm Reductionist Perspective
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, both the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In the first episode, we catch up with Lisa Raville -- executive director of the Harm Reduction Action Center in Denver -- to learn how COVID has impacted her facility’s daily operations as well as the lives of her clients. For more information about HRAC: Get In touch with HRAC: Email: HRAC.Denver@gmail.com Facebook: Twitter: @HRAC_Denver Instagram: @harmreductionactioncenter ______________________________________ Illustration by Kelly Caminero/The Daily Beast/Shutterstock
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UnfilterED Clips: A Toxicologist's Perspective on COVID-19, Biological Warfare and the Need for Disaster Preparedness
06/27/2020
UnfilterED Clips: A Toxicologist's Perspective on COVID-19, Biological Warfare and the Need for Disaster Preparedness
Taken from 'UnfilterED #8: Dr. Christopher Hoyte'. “This current sars-coV-2 / COVID-19 situation should really be a wake-up call for not just a pandemic, but for a biological attack...One of the things I would like to do when we bring our attention back from COVID and get through this pandemic is to really start to prepare for disaster preparedness on the level and scale that we need to for a biological attack and get our hospitals ready, my poison center ready, state and local governments ready so that we can meet that challenge when it happens.” - Dr. Chris Hoyte Dr. Chris Hoyte is an ED physician, toxicologist and researcher based in Denver, CO. He was featured in , a book celebrating emergency physicians through personal testimonies and photography on the frontlines captured by legendary photographer, Eugene RIchards. Photo © courtesy Eugene Richards
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UnfilterED #8: Dr. Christopher Hoyte
06/24/2020
UnfilterED #8: Dr. Christopher Hoyte
Dr. Chris Hoyte is an ED physician, toxicologist and researcher based in Denver, CO. He was featured in , a book celebrating emergency physicians through personal testimonies and photography on the frontlines captured by legendary photographer, Eugene RIchards. Time Stamps: 01:25 - Dr. Hoyte’s Origin Story 05:01 - What Drew Dr. Hoyte to Medical Toxicology? 08:22 - Dr. Hoyte’s Most Interesting Toxicology Cases 08:52 - King Cobra Bite 13:31 - Verapamil Overdose 16:47 - Mass Cyanide Poisoning 19:16 - The Looming Threat of Biological Warfare and the Need for Emergency Preparedness 25:07 - How COVID-19 Affected Dr. Hoyte’s Job as a Toxicologist 30:19 - How Does the Rocky Mountain Poison and Drug Center Handle Its Large Workload 35:56 - Cannabinoid Exposures 42:05 - The Future of Toxicology Publications from Dr. Hoyte: A Characterization of Synthetic Cannabinoid Exposures Reported to the National Poison Data System in 2010 An Outbreak of Exposure to a Novel Synthetic Cannabinoid The Continued Impact of Marijuana Legalization on Unintentional Pediatric Exposures in Colorado Pediatric Death Due to Myocarditis After Exposure to Cannabis Anaphylaxis to Black Widow Spider Antivenom 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 574: Cyanide Toxicity
06/23/2020
Podcast 574: Cyanide Toxicity
Contributor: Nick Tsipis, MD Educational Pearls: Significant cyanide exposure most commonly occurs from fire/smoke exposure particularly when plastics are involved Cyanide binds to cytochrome oxidase leading to the use of anaerobic metabolism which causes a profound lactic acidosis Classic toxicity includes a rapid loss of consciousness, hypotension, bradycardia, respiratory depression, and seizures Mild exposures can lead to nausea/vomiting, headaches, and other nonspecific symptoms. Sometimes patients will complain of an almond taste. Cyanide toxicity will manifest on labs by a profound anion gap acidosis with elevated lactate (but don't wait for them to ponder the diagnosis) Antidote is hydroxocobalamin and sodium thiosulfate Severe cyanide exposure will likely need ICU level care until the blood gas levels return to their baselines and the lactic acidosis resolves References Nickson Chris C, Australian Centre for Health Innovation at Alfred Health. Cyanide Poisoning • LITFL • CCC Toxicology. Life in the Fast Lane • LITFL • Medical Blog. https://litfl.com/cyanide-poisoning-ccc/. Published April 2, 2019. Accessed June 11, 2020. Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP. Challenges in the diagnosis of acute cyanide poisoning. Clin Toxicol (Phila). 2018;56(7):609‐617. doi:10.1080/15563650.2018.1435886 MacLennan L, Moiemen N. Management of cyanide toxicity in patients with burns. Burns. 2015;41(1):18‐24. doi:10.1016/j.burns.2014.06.001 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 573: Arsenic Toxicity
06/22/2020
Podcast 573: Arsenic Toxicity
Contributor: Nick Tsipis, MD Educational Pearls: Arsenic is a heavy metal that binds to multiple cellular enzymes and inhibits aerobic metabolism It is primarily absorbed through the skin, respiratory and GI tract. The classic symptoms of heavy metal exposure are GI irritation (watery diarrhea, vomiting and abdominal pain) with multisystem organ failure. Neuropathy can present insidiously Initial work up includes EKG, and basic lab work (expect a delayed rise in liver function tests). Acute arsenic ingestions can sometimes show up on imaging as it is radioapaque Diagnosis is usually made with the history and evidence of multisystem organ failure. Treatment should be coordinated with your local Poison Control or toxicologist and involves predominantly supportive care along with chelating agents succimer (oral) or dimercaprol (intramuscular) References ong N. Arsenic toxicity • LITFL • Toxicology Library Toxicant. Life in the Fast Lane • LITFL • Medical Blog. https://litfl.com/arsenic-toxicity/. Published August 25, 2019. Kuivenhoven M, Mason K. Arsenic (Arsine) Toxicity. [Updated 2019 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541125/
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Preview: The Black Doctors Podcast
06/21/2020
Preview: The Black Doctors Podcast
In addition to producing our own content, we believe in using our platform to amplify other voices and perspectives in medicine. With that in mind, check out 'The Black Doctor Podcast' from Dr. Steven Bradley which features interviews with leading minority professionals of the current generation as well as stories of how they overcame adversity and attained their goals. "Listen and be inspired." Podcasts available on , and all other major streaming platforms Twitter: @StevenBradleyMD Instagram: @theblackdoctorspodcast
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Podcast 572: Locked In Syndrome
06/16/2020
Podcast 572: Locked In Syndrome
Contributor: Aaron Lessen, MD Educational Pearls: Locked in syndrome results typically from an infarct of the basilar artery leading to infarction of the brainstem but typically preservation of the higher structures The result is complete paralysis with preserved cognitive function, hence the name Because of their location within the brainstem, ocular movements are sometimes preserved, allowing a patient who recovers from the initial injury to communicate Patients typically do not regain any motor function and have a poor prognosis of recovery Thrombectomy of the basilar artery is sometimes considered even late after the initial presentation given the devastating prognosis References Smith E, Delargy M. Locked-in syndrome. BMJ. 2005;330(7488):406‐409. doi:10.1136/bmj.330.7488.406 Buchman SL, Merkler AE. Basilar Artery Occlusion: Diagnosis and Acute Treatment. Curr Treat Options Neurol. 2019;21(10):45. Published 2019 Sep 26. doi:10.1007/s11940-019-0591-0 Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, et alMechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulationJournal of NeuroInterventional Surgery 2019;11:1174-1180. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 571: Digital Blocks
06/15/2020
Podcast 571: Digital Blocks
Contributor: Jared Scott, MD Educational Pearls: Traditional digital block involves dorsal approach on either side of the digit, injecting local anesthetic along each side to numb all four nerves of the digit Newer approach involves a single injection along the palmar surface at MCP joint Recent study further compared a proximal vs distal single palmar (volar) injection with sites at the MCP and PIP joints Injection sites achieved similar anesthesia between groups but PIP injection site had faster time of onset - 2.5 minutes compared to 3.8 minutes References Choi S, Cho YS, Kang B, Kim GW, Han S. The difference of subcutaneous digital nerve block method efficacy according to injection location. Am J Emerg Med. 2020;38(1):95‐98. doi:10.1016/j.ajem.2019.04.031 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 570: Oh no no no to O2
06/09/2020
Podcast 570: Oh no no no to O2
Contributor: Aaron Lessen, MD Educational Pearls: Supplemental oxygen is not a completely benign intervention. A recent meta-analysis found that O2 saturations above 96% while on supplemental O2 were associated with worse outcomes. Only start a patient on supplemental oxygen if absolutely necessary and aim for a goal of no higher than 96% References Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Schünemann, John D Neary, Waleed Alhazzani. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet. Volume 391, Issue 10131. 2018. Pages 1693-1705, Summarized by Will Dewispelaere, MD | Edited by Erik Verzemnieks, MD
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Podcast 570: Oh no no no to O2
06/09/2020
Podcast 570: Oh no no no to O2
Contributor: Aaron Lessen, MD Educational Pearls: Supplemental oxygen is not a completely benign intervention. A recent meta-analysis found that O2 saturations above 96% while on supplemental O2 were associated with worse outcomes. Only start a patient on supplemental oxygen if absolutely necessary and aim for a goal of no higher than 96% References Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Schünemann, John D Neary, Waleed Alhazzani. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet. Volume 391, Issue 10131. 2018. Pages 1693-1705, Summarized by Will Dewispelaere, MD | Edited by Erik Verzemnieks, MD
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Podcast 569: The eFAST Exam
06/08/2020
Podcast 569: The eFAST Exam
Contributor: Aaron Lessen, MD Educational Pearls:. Focused assessment with Sonography for Trauma (FAST) exam and the extended-FAST (eFAST) are essential components of current trauma care and evaluation There has been an accumulation of research to provide an estimate of effectiveness of identifying certain injuries with ultrasound: For identifying a pneumothorax, the sensitivity ~70% and specificity ~99%. For pericardial effusions, sensitivity 90% and specificity ~ 94%. For hemoperitoneum, sensitivity ~74% and the specificity ~98%. While ultrasound is excellent for identifying many injuries, it may not be adequate alone to rule out serious injuries if the clinical suspicion is high based on these pooled studies References Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM. 2019;21(6):727‐738. doi:10.1017/cem.2019.381 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 569: The eFAST Exam
06/08/2020
Podcast 569: The eFAST Exam
Contributor: Aaron Lessen, MD Educational Pearls:. Focused assessment with Sonography for Trauma (FAST) exam and the extended-FAST (eFAST) are essential components of current trauma care and evaluation There has been an accumulation of research to provide an estimate of effectiveness of identifying certain injuries with ultrasound: For identifying a pneumothorax, the sensitivity ~70% and specificity ~99%. For pericardial effusions, sensitivity 90% and specificity ~ 94%. For hemoperitoneum, sensitivity ~74% and the specificity ~98%. While ultrasound is excellent for identifying many injuries, it may not be adequate alone to rule out serious injuries if the clinical suspicion is high based on these pooled studies References Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM. 2019;21(6):727‐738. doi:10.1017/cem.2019.381 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD
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Podcast 568: Shock ‘em!
06/02/2020
Podcast 568: Shock ‘em!
Contributor: John Winkler, MD Educational Pearls: Unstable ventricular tachycardia (VT) typically manifests with syncope, shortness of breath, diaphoresis and/or chest pain with hemodynamic instability Electrical cardioversion of unstable ventricular tachycardia is first line treatment Starting with a higher energy level (or just using the maximum) when performing cardioversion may set you up for better success as many providers feel the first shock has the highest likelihood of success References Dresen, W.F. Ferguson, J.D. Ventricular Arrhythmias. 2018 Feb;36(1):129-139. doi: 10.1016/j.ccl.2017.08.007. Epub 2017 Oct 27. Goyal, A. et al. Synchronized Electrical Cardioversion.StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020-. 2020 Feb 13. Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
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