Emergency Medical Minute

Podcast #447: IV Tylenol 03/20/2019

Podcast #447: IV Tylenol Author: Dylan Luyten, MD Educational Pearls: Recent randomized controlled trial compared intravenous to oral acetaminophen in emergency department patients There was no difference in pain relief between the groups While the actual acquisition cost of these drugs are not significant, the cost multipliers that are passed onto patients lead to real dollars With the significant cost of IV acetaminophen, it may not be the best choice given the lack of superiority to other formulations References: Furyk J, Levas D, Close B, Laspina K, Fitzpatrick M, Robinson K, Vangaveti VN, Ray R. Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial.Emerg Med J. 2018 Mar;35(3):179-184. doi: 10.1136/emermed-2017-206787. Epub 2017 Dec 15. PubMed PMID: 29247042. Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/9087185

Podcast #446: Retinal Detachment 03/19/2019

Podcast #446: Retinal Detachment Author: Dylan Luyten, MD Educational Pearls: 1:500 patients will experience a retinal detachment Consider stroke on your differential (central retinal arterial occlusion) Flashes and floaters are a common complaint with retinal detachments Though patients may report fields of vision loss, visual acuity is often spared Ocular ultrasound is an effective way to diagnosis retinal detachment in the ED These require urgent ophthalmologic consultation for surgical repair References: https://www.aliem.com/2014/03/ocular-ultrasound-retinal-detachment-posterior-vitreous-detachment/ Gottlieb M, Holladay D, Peksa GD. Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis. Acad Emerg Med. 2019 Jan 13. doi: 10.1111/acem.13682. [Epub ahead of print] PubMed PMID: 30636351. Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/9058598

UNTAMED PART 6: Stepping Back Into Life 03/11/2019

UNTAMED PART 6: Stepping Back Into Life /episode/index/show/emergencymedicalminute/id/8955683

UNTAMED PART 5: Too High 03/11/2019

UNTAMED PART 5: Too High /episode/index/show/emergencymedicalminute/id/8955632

UNTAMED PART 4: A New Perspective 03/11/2019

UNTAMED PART 4: A New Perspective /episode/index/show/emergencymedicalminute/id/8955617

UNTAMED PART 3: Coping With Pain 03/11/2019

UNTAMED PART 3: Coping With Pain /episode/index/show/emergencymedicalminute/id/8955584

UNTAMED PART 2: Surviving a Medical Emergency in the Outdoors 03/11/2019

UNTAMED PART 2: Surviving a Medical Emergency in the Outdoors /episode/index/show/emergencymedicalminute/id/8955428

UNTAMED PART 1: The Physiology of Experiencing Nature 03/11/2019

UNTAMED PART 1: The Physiology of Experiencing Nature /episode/index/show/emergencymedicalminute/id/8955284

Podcast #445: Hunting for the endotracheal tube 03/08/2019

Podcast #445: Hunting for the endotracheal tube Author: Michael Hunt, MD Educational Pearls: Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive and 97.1% specific Curvilinear probe may be preferable as it provides a larger field of view Editor’s Note: rather than explain what you’re looking for… just go here References: Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2018 Dec;72(6):627-636. doi: 10.1016/j.annemergmed.2018.06.024. Epub 2018 Aug 14. PubMed PMID: 30119943. Summarized and edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8863517

Podcast #444: Dyspnea in the intubated patient 03/06/2019

Podcast #444: Dyspnea in the intubated patient Author: Aaron Lessen, MD Educational Pearls: Dyspnea can occur in up to 50% of intubated patients Dyspnea is associated with prolonged mechanical intubation Often goes undiagnosed as these patients have difficulty communicating Expert opinion on reducing sensation of dyspnea Reduce stimulation of respiratory drive like fever and acidosis Give bronchodilators for patients with wheezing Optimize the ventilator settings Use medications for comfort (i.e. opioids, benzodiazepines) References: Decavèle M, Similowski T, Demoule A. Detection and management of dyspnea in mechanically ventilated patients. Curr Opin Crit Care. 2019 Feb;25(1):86-94. doi: 10.1097/MCC.0000000000000574. PubMed PMID: 30531366. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8854367

Podcast #443: Measles - a timely revisit 03/04/2019

Podcast #443: Measles - a timely revisit Author: Sue Chilton, MD Educational Pearls: Measles is highly contagious Typically patients just look sick Remember 4 & 4, 14, and 4-C’s: Contagious 4 days before and after onset of rash 14 days for rash to appear Cough, coryza, conjunctivitis (non-purulent), and Koplik’s spots Under 2 and over 20 are highest risk groups 1 in 1000 will die Subacute sclerosing panencephalitis is one of the most feared, degenerative, 100% fatal complications that can occur up to two decades after initial infection Editor’s Note: Don’t be pro-plague - if you can, vaccinate your children. References: https://www.denverpost.com/2019/01/16/denver-measles-exposure/ Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. Review. PubMed PMID: 28673424. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 1;170(12):1209-1215. doi: 10.1001/jamapediatrics.2016.1787. Review. PubMed PMID: 27695849. Summarized and edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8855084

Podcast #442: When a severe man cold isn’t 03/02/2019

Podcast #442: When a severe man cold isn’t Author: Jared Scott, MD Educational Pearls: CXR is 40-90% sensitive for detecting pneumonia when compared to CT Patients with a high degree of suspicion for pneumonia may still warrant treatment despite a negative CXR References: Self WH, Courtney DM, McNaughton CD, Wunderink RG, Kline JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013 Feb;31(2):401-5. doi: 10.1016/j.ajem.2012.08.041. Epub 2012 Oct 18. PubMed PMID: 23083885; PubMed Central PMCID: PMC3556231. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8846054

Podcast #441: Is Heparin Worthless for ACS? 02/27/2019

Podcast #441: Is Heparin Worthless for ACS? Author: Don Stader, MD Educational Pearls: Recent study demonstrated patients with non-STEMI treated with heparin had no difference in survival, but had an increased risk of major bleeding Heparin may be an outdated medication in the era of dual anti-platelet therapy and PCI Heparin may fall to the wayside like other former treatments for ACS such as morphine, oxygen and nitroglycerin as far as mortality benefit References: Chen JY, He PC, Liu YH, Wei XB, Jiang L, Guo W, Duan CY, Guo YS, Yu XP, Li J, Li WS, Zhou YL, Lin CY, Luo JF, Yu DQ, Chen ZJ, Chen W, Chen YY, Guo ZQ, Geng QS, Tan N. Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome. JAMA Intern Med. 2019 Feb 1;179(2):186-194. doi: 10.1001/jamainternmed.2018.5953. PubMed PMID: 30592483 Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8768957

Podcast # 440 : Carbon Monoxide Poisoning 02/25/2019

Podcast # 440 : Carbon Monoxide Poisoning Author: Katie Sprinkle, MD Educational Pearl: Carbon monoxide (CO) is the leading cause of death from poison world-wide CO forms from the combustion of any carbon based product Patients often present with non specific symptom like headache, vomiting, and malaise Consider this diagnosis with multiple people presenting with similar symptoms from a single location Treatment is with high flow oxygen (i.e. non-rebreather) Hyperbaric therapy is controversial and up for debate - discussion with local consultants may help guide this management/transfer Tobacco smokers typically have elevated levels of carbon monoxide at baseline Editor’s Note: smoking hookah for one hour may be the equivalent of smoking nearly 100 cigarettes References: Jacob P, Abu Raddaha AH, Dempsey D, et al. Nicotine, carbon monoxide, and carcinogen exposure after a single use of a water pipe. Cancer Epidemiol Biomarkers Prev. 2011;20(11):2345-53. Ng PC, Long B, Koyfman A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med. 2018 Mar;13(2):223-229. doi: 10.1007/s11739-018-1798-x. Epub 2018 Feb 12. Review. Erratum in: Intern Emerg Med. 2018 Mar 22;:. PubMed PMID: 29435715. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning:., Wolf SJ, Maloney GE, Shih RD, Shy BD, Brown MD. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning. Ann Emerg Med. 2017 Jan;69(1):98-107.e6. doi: 10.1016/j.annemergmed.2016.11.003. PubMed PMID: 27993310. Guzman JA. Carbon monoxide poisoning. Crit Care Clin. 2012 Oct;28(4):537-48. doi: 10.1016/j.ccc.2012.07.007. Review. PubMed PMID: 22998990. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8768447

Podcast # 438 : tPA for Frostbite 02/22/2019

Podcast # 438 : tPA for Frostbite Author: Aaron Lessen, MD Educational Pearls: Several studies have shown administration of tPA can improve outcomes and reduce need for amputation tPA is considered in grade III and IV frostbite tPA cannot be given until after the warming process Administration is systemically, not catheter directed or intra-arterial References: Jones LM, Coffey RA, Natwa MP, Bailey JK. The use of intravenous tPA for the treatment of severe frostbite. Burns. 2017 Aug;43(5):1088-1096. doi: 10.1016/j.burns.2017.01.013. Epub 2017 Jan 31. PubMed PMID: 28159151. Wexler A, Zavala S. The Use of Thrombolytic Therapy in the Treatment of Frostbite Injury. J Burn Care Res. 2017 Sep/Oct;38(5):e877-e881. doi: 10.1097/BCR.0000000000000512. PubMed PMID: 28296671. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8684000

Podcast # 439 : Oops I did it again 02/22/2019

Podcast # 439 : Oops I did it again Author: Aaron Lessen, MD Educational Pearl: A double ingestion of a single pill is typically a benign event but several drug classes may cause problems A published review of 10 years of single medication double dose ingestion found 12 out of 876 cases had adverse events. The drugs and events were: Propafenone ingestion leading to ventricular tachycardia Beta blocker ingestion leading to bradycardia and hypotension Calcium channel blocker leading to bradycardia and hypotension Bupropion ingestion leading to seizures Tramadol ingestion leading to ventricular tachycardia Editor’s Note: References: Correia MS, Whitehead E, Cantrell FL, Lasoff DR, Minns AB. A 10-year review of single medication double-dose ingestions in the nation's largest poison control system. Clin Toxicol (Phila). 2019 Jan;57(1):31-35. doi: 10.1080/15563650.2018.1493205. Epub 2018 Nov 28. PubMed PMID: 30484705. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8728349

Podcast # 437 : Myasthenia Gravis 02/20/2019

Podcast # 437 : Myasthenia Gravis Podcast # 437 : Myasthenia Gravis Author: Gretchen Hinson, MD Educational Pearls: Myasthenia gravis (MG) is an antibody mediated autoimmune disorder against the acetylcholine receptors at the neuromuscular junctions. Bimodal age distribution (20’s-30’s: women; 60’s-70’s: men) Presents with fluctuating muscle weakness typically worse at the end of the day with upper extremities affected more than lower and typically involving facial muscles. Myasthenia crisis occurs when muscle fatigue begins to cause respiratory depression MG was historically diagnosed with the Tensilon test but now often by EMG Treatment of MG crisis involves plasma exchange and IVIG. Those in crisis often require intubation and ICU admission References: Gilhus NE. Myasthenia Gravis. N Engl J Med. 2016 Dec 29;375(26):2570-2581. doi: 10.1056/NEJMra1602678. Review. PubMed PMID: 28029925. Roper J, Fleming ME, Long B, Koyfman A. Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department. J Emerg Med. 2017 Dec;53(6):843-853. doi: 10.1016/j.jemermed.2017.06.009. Epub 2017 Sep 12. PubMed PMID: 28916122. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8683889

Podcast # 436 : Epinephrine Autoinjectors 02/18/2019

Podcast # 436 : Epinephrine Autoinjectors Author: Charleen Gnisci, PharmD Educational Pearls: Between 2011 to 2016, Mylan increased EpiPen prices by 400% ($700 for 2 packs) AUVI-Q was recalled in 2012, which left the market share to the EpiPen until recently Teva announced last year it will be making a generic version of the EpiPen retailing around $300 but expected to decrease References: Kaplan, S. F.D.A. Approves Generic EpiPen That May Be Cheaper. The New York Times, The New York Times, 2018. Retrived from www.nytimes.com/2018/08/16/health/epipen-generic-drug-prices.html. Tirrell, M. FDA approves Teva's generic EpiPen after yearslong delay. 2018. Retrieved from https://www.cnbc.com/2018/08/16/fda-approves-tevas-generic-epipen-after-years-long-delay.html Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8672858

Podcast # 435 : UCL Injury 02/15/2019

Podcast # 435 : UCL Injury Author: Ryan Circh, MD Educational Pearls: Ulnar collateral ligament injury is often called gamekeeper’s thumb or skier’s thumb Can results from traumatic deviating the thumb radially (abduction) Poor rabbits Have a low threshold for referral to hand surgery for follow up - treatment for minor injuries can be conservative but more severe require surgery to preserve function This injury should be placed in a thumb spica splint Radiographs are often negative unless an avulsion fracture is present Editor’s note: to test for UCL injuries, I like this. References: Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med. 2015 Jan;34(1):117-26. doi: 10.1016/j.csm.2014.09.004. Epub 2014 Oct 11. Review. PubMed PMID: 25455399. Madan SS, Pai DR, Kaur A, Dixit R. Injury to ulnar collateral ligament of thumb. Orthop Surg. 2014 Feb;6(1):1-7. doi: 10.1111/os.12084. Review. PubMed PMID: 24590986. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8657342

Podcast # 434 : TIA 02/13/2019

Podcast # 434 : TIA Author: Peter Bakes, MD Educational Pearl: Transient ischemic attack (TIA) is defined as neurologic symptoms that resolve in 24 hours with no new changes on head imaging Mimics include complex migraine, carotid dissection, seizure (Todd’s paralysis) Typical presentation is with sudden onset of negative symptoms such as numbness, weakness, etc. Mimics tend to have positive symptoms such as photophobia, pain, etc. References: Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160. Simmons B, et al. Transient Ischemic Attack: Part I. Diagnosis and Evaluation. American Family Physician 2012; 86(6):521-526. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8631680

Podcast # 433: Geriatric Ketamine 02/09/2019

Podcast # 433: Geriatric Ketamine Author: Michael Hunt, MD Educational Pearls: Recent study compared ketamine to morphine in elderly patient Ketamine (IV dose 0.3 mg /kg) provided equivalent pain control to morphine (IV dose 0.1 mg / kg) However, etamine group had much higher rate of side effects, including psychoperceptual A lower does of 0.1 mg / kg given intravenously over 15 minutes might be a better option to start in the elderly population - you can always add more! References Motov S, Mann S, Drapkin J, Butt M, Likourezos A, Yetter E, Brady J, Rothberger N, Gohel A, Flom P, Mai M, Fromm C, Marshall J. Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial. Am J Emerg Med. 2019 Feb;37(2):220-227. doi: 10.1016/j.ajem.2018.05.030. Epub 2018 May 16. PubMed PMID: 29807629. Summarized and edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8579486

Podcast # 432: Hunting for UTIs 02/07/2019

Podcast # 432: Hunting for UTIs Author: Michael Hunt, MD Educational Pearls: As many as 20% of women in assisted living have asymptomatic bacteriuria This can present a diagnostic conundrum when seeing these patients in the emergency department, particularly for altered mental status and deciding whether to treat True diagnosis of UTI in the emergency department is difficult as true diagnoses required culture results and repeated positive samples Procalcitonin is an emerging biomarker that may be helpful in determining the presence of infection References: Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults. Infect Dis Clin North Am. 2017 Dec;31(4):673-688. doi: 10.1016/j.idc.2017.07.002. Review. PubMed PMID: 29079155; PubMed Central PMCID: PMC5802407. Huang DT, Angus DC, Chang CH, Doi Y, Fine MJ, Kellum JA, Peck-Palmer OM, Pike F, Weissfeld LA, Yabes J, Yealy DM; ProACT Investigators.. Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection. BMC Emerg Med. 2017 Aug 29;17(1):25. doi: 10.1186/s12873-017-0138-1. PubMed PMID: 28851296; PubMed Central PMCID: PMC5576372. Summarized by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8559983

Podcast # 431: Medication Errors 02/04/2019

Podcast # 431: Medication Errors Author: Rachel Brady, MD Educational Pearls: Medication errors are estimated to be the 3rd leading cause of death A 2016 study estimated 250,000 errors occur per year, with 7000-9000 leading to death About 50% are in the ordering/prescribing phase; 25-30% during administration phase. Overworked and distracted providers are the most common underlying reasons for medication error A 2017 study found 40% of ED nurses witnessed a medication error in the last year Editor’s Note: This is a reasonable counterpoint References Farag A, Blegen M, Gedney-Lose A, Lose D, Perkhounkova Y. Voluntary Medication Error Reporting by ED Nurses: Examining the Association With Work Environment and Social Capital. J Emerg Nurs. 2017 May;43(3):246-254. doi: 10.1016/j.jen.2016.10.015. Epub 2017 Mar 28. PubMed PMID: 28359712. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 May 3;353:i2139. doi: 10.1136/bmj.i2139. PubMed PMID: 27143499. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8516537

Podcast # 430: Humeral IO 01/30/2019

Podcast # 430: Humeral IO Author: Aaron Lessen, MD Educational Pearls: Choose the longest needle for the humeral IO Internally rotate and adduct the patients hand (resting on umbilicus) for best access to the site Aim 1 cm superior to the greater tuberosity of the humerus with the needle angled 45 degrees inferiorly Maintaining the line is critical - keep arm internally rotated with sling, tape or whatever works References Kovar J, Gillum L. Alternate route: the humerus bone - a viable option for IO access. JEMS. 2010 Aug;35(8):52-9. doi: 10.1016/S0197-2510(10)70207-2. PubMed PMID: 20708143. http://epmonthly.com/article/get-humeral-io-access/ Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8454107

Podcast # 429: Oldschool Syphilis Treatment 01/28/2019

Podcast # 429: Oldschool Syphilis Treatment Author: Chris Holmes, MD Educational Pearls: In WWI, the 2nd leading cause of soldier disability were STDs. An early treatment of syphilis included topical and inhaled mercury Bloodletting, vitriol, arsenic, and bismuth were other treatments for syphilis. Infecting patients with Malaria and treating the Malaria was also tried Thankfully penicillin was discovered for our syphilis woes References Frith J. . Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. Journal of Military and Veterans Health. 2012. 20(4): 49-58 https://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/ Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8418176

Podcast # 428: Severe Hypothyroidism 01/27/2019

Podcast # 428: Severe Hypothyroidism Author: Gretchen Hinson, MD Educational Pearls: Clinical manifestations of severe hypothyroidism may include: Pale, cool, diaphoretic skin Myxedema is the non-pitting edema seen in hypothyroidism Hypothermia, heart failure, hypotension and shock Shortness of breath Cholestasis, constipation Encephalopathy and coma Mortality is 30-50% Specific treatment includes thyroid hormone (T3, T4, or both) and glucocorticoids (for potential adrenal insufficiency) References: Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007 Jul-Aug;22(4):224-31. Review. PubMed PMID: 17712058. Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017 Mar;27(3):117-122. doi: 10.1016/j.je.2016.04.002. Epub 2017 Jan 5. PubMed PMID: 28142035; PubMed Central PMCID: PMC5350620. Lee CH, Wira CR. Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency. Am J Emerg Med. 2009 Oct;27(8):1021.e1-2. doi: 10.1016/j.ajem.2008.12.027. PubMed PMID: 19857436. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8408702

Podcast # 427: Cookie Dough is Delicious 01/24/2019

Podcast # 427: Cookie Dough is Delicious Author: Eric Miller, MD Educational Pearls: Recent CDC statement warms against consumption of cookie dough Two common ingredients can pose risk: eggs and flour Flour in dough is a raw agricultural product not treated to kill E. coli A 2016 E. coli outbreak was linked to flour References: https://www.cdc.gov/features/no-raw-dough/index.html https://www.cdc.gov/ecoli/2016/o121-06-16/index.html Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8354033

Podcast # 426: Ho Ho - Oh No! 01/22/2019

Podcast # 426: Ho Ho - Oh No! Author: Katrina Iverson, MD Educational Pearls: The winter holiday months present a unique picture of patient presentations to the emergency department Some of the unique presentations include: Children falling off Santa’s lap Sledding injuries Falling off ladders Lacerations, ingestion, and insertion of broken ornaments (pediatrics) Parents tend to hurt themselves on their children’s toys References: Lauche R, et al. (2018). ‘Santa baby, hurry [extra carefully] down the chimney tonight’ – Prevalence of Christmas related injuries 2007–2016 in the United States: Observational study. Advances in Integrative Medicine. https://doi.org/10.1016/j.aimed.2018.11.004 https://areyouawellbeing.texashealth.org/common-winter-injuries/ Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8351915

Podcast # 425: Oseltamivir Efficacy in Children 01/18/2019

Podcast # 425: Oseltamivir Efficacy in Children Author: Aaron Lessen, MD Educational Pearls: Recent meta-analysis reviewed efficacy oseltamivir (Tamiflu) in pediatric populations treated for influenza, showing an 18 hour reduction in duration of illness for those with laboratory confirmed influenza Those with suspected influenza unsurprisingly had less effect Subgroup analysis showed most benefit in those treated within the first 24 hours of symptom onset Patients with confirmed influenza treated with oseltamivir had a 34% reduction in risk of otitis media Editor’s note: Vomiting was higher in the treatment groups; There were no significantly different outcomes in regards to other endpoints, such as lower respiratory tract infections and hospitalizations References: Malosh RE, Martin ET, Heikkinen T, Brooks WA, Whitley RJ, Monto AS. Efficacy and Safety of Oseltamivir in Children: Systematic Review and Individual Patient Data Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2018 May 2;66(10):1492-1500. doi: 10.1093/cid/cix1040. PubMed PMID: 29186364. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8293103

Podcast # 424: Hunting for Measles 01/16/2019

Podcast # 424: Hunting for Measles Author: Mike Hunt, MD Educational Pearls: Measles is highly contagious and successfully infects 90% of those at risk exposed to the virus. 10 day prodrome where patients are asymptomatic. 3 day period of characteristic cough, coryza, conjunctivitis, fever and Koplick spots with a maculopapular rash that moves from head through trunk Infection risk extends three to four days after the onset of rash but also three to four days prior to onset. Have fun with that. A potential exposure, say in an emergency department waiting room, needs review of any exposed patient’s immunization history to contain spread References: Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. Review. PubMed PMID: 28673424. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 1;170(12):1209-1215. doi: 10.1001/jamapediatrics.2016.1787. Review. PubMed PMID: 27695849. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD /episode/index/show/emergencymedicalminute/id/8282282

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