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.

Podcast 1025: Post intubation Sedation 10/12/2026

Podcast 1024: Caffeine Toxicity 10/05/2026

Podcast 1024: Caffeine Toxicity Contributor: Taylor Lynch, MD Educational Pearls: Excessive caffeine intake can be dangerous. For normal adults, the toxicity level starts at 1000mg, which is equivalent to about 10 cups of coffee or 5 celsius drinks. For normal adults, lethal levels are about 5-10 grams, which is equivalent to about 50-100 cups of coffee. Most of these outcomes are not from drinking caffeine, but instead concentrated caffeine pills. For children, toxic levels are 15mg per kg of the child. Within the last 10 years 20-40 deaths due to caffeine intake have been reported. This may be lower than the actual number due to cardiac arrests that potentially could have been caused from caffeine intake. Clinical presentation of caffeine toxicity can present in many ways. Most common symptoms include agitation and jitteriness The far end of the spectrum includes seizures, tachydysrhythmias, and eventually cardiovascular collapse. Caffeine is a part of the methylxanthine class. Caffeine is a phosphodiesterase inhibitor, which causes the release of calcetamines that act on your beta-2 receptors. This activates the sodium potassium ATPase and causes potassium to shift intracellular. The clinical presentation of this mechanism is a patient with low potassium and agitation. Treatments for toxic caffeine levels include: Replacing potassium, but slowly since the total potassium levels in the body are normal and will eventually return to normal once the caffeine wears off. Benzodiazepines Activated charcoal Dialysis, since caffeine is dialyzable References National Center for Biotechnology Information. "PubChem Compound Summary for CID 2519, Caffeine" PubChem, . Accessed 9 July, 2026. Murray A, Traylor J. Caffeine Toxicity. [Updated 2025 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: Cyril Willson, The clinical toxicology of caffeine: A review and case study, Toxicology Reports, Volume 5, 2018, Pages 1140-1152, ISSN 2214-7500, . Summarized by Aaryn David | Edited by Aaryn David & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: Golf Fundraiser: /episode/index/show/emergencymedicalminute/id/43170218

Podcast 1023: Torsades de pointes 09/28/2026

Podcast 1022: Emergent Dialysis 09/21/2026

Podcast 1022: Emergent Dialysis Contributor: Taylor Lynch, MD Educational Pearls: When a patient who missed dialysis presents to the emergency department, our clinical concern is who needs to be admitted to the hospital for emergent dialysis and who can wait for their next regularly scheduled session. Dialysis sessions typically occur on Monday, Wednesday, and Friday, or Tuesday, Thursday, and Saturday. Acronym for indications for emergent dialysis: AEIOU Acidosis Patients may have an underlying cause for acidosis such as sepsis or DKA. Treat the underlying cause, but if the acidosis is unable to be corrected, the patient needs dialysis. Electrolytes Most commonly elevated is potassium. In general, dialysis patients tend to have higher potassium levels, so don’t just treat the number. Look for potassium greater than 6.5 or if EKG changes are present. Ingestion Intoxication with substances such as Lithium, Ethylene Glycol, Methanol, Salicylates. Overload Patients may present with evidence of fluid overload such as new oxygen requirement or pulmonary edema. If they are making urine, treat with diuretics, but if unresponsive to medical therapy, they will require dialysis. Uremia Build-up of nitrogenous waste products in the blood, which is indicated by an elevated BUN. Patients may develop complications such as altered mentation or pericardial effusions and subsequent cardiac tamponade. Keep in mind creatinine itself is not an indication for emergent dialysis. Serves as a surrogate marker of kidney function. Can be high or low depending on muscle mass or kidney filtration, and the patient may or may not need dialysis. References: Jentzer JC, Bihorac A, Brusca SB, et al. Contemporary Management of Severe Acute Kidney Injury and Refractory Cardiorenal Syndrome: JACC Council Perspectives. J Am Coll Cardiol. 2020;76(9):1084-1101. doi:10.1016/j.jacc.2020.06.070 Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42968393

Podcast 1021: Pulmonary Edema From Naloxone Administration 09/14/2026

Podcast 1021: Pulmonary Edema From Naloxone Administration Contributor: Travis Barlock, MD Educational Pearls: What is pulmonary edema? Pulmonary edema is the accumulation of fluid initially in the interstitium of the lungs, that when severe enough can also accumulate in the alveolar air sacs. It develops when the rate of fluid filtration through the pulmonary vasculature out-paces the lymphatics ability to drain the fluid. There are 2 theories for what causes pulmonary edema in the setting of naloxone administration: catecholamine surge vs negative pressure/barotrauma Catecholamine Surge : Naloxone administration precipitates an acute opioid withdrawal in which epinephrine and norepinephrine surge causing marked vasoconstriction on both the heart and the lungs Negative Pressure/Barotrauma: This mechanism is not directly naloxone related but may be confounded by opioid effects. High dose synthetic opioids can induce sustained laryngospasm that is not mu-opioid mediated (thus not easily reversed by naloxone). With rapid awakening, respiratory muscles induce a negative pressure in the thoracic cavity against a closed glottis. This results in an alveolar barotrauma and a transudative pulmonary edema. What is the treatment for pulmonary edema secondary to opioid overdose reversal? Positive pressure ventilation is the mainstay treatment (CPAP/BiPAP) with oxygen supplementation. Importantly, diuretics are not recommended. The patient is not fluid overloaded like in the case of other pulmonary edemas, and diuresing the patient can worsen kidney injury which is already at an increased risk in opioid overdoses (rhabdomyolysis in particular). References: Saari TI, Strang J, Dale O. Clinical Pharmacokinetics and Pharmacodynamics of Naloxone. Clin Pharmacokinet. 2024;63(4):397-422. doi: DailyMed - NALOXONE HYDROCHLORIDE injection, solution. Boyer EW. Management of Opioid Analgesic Overdose. New England Journal of Medicine. 2012;367(2):146-155. doi: Dezfulian C, Orkin AM, Maron BA, et al. Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation. 2021;143(16):e836-e870. doi: Kienbaum P, Thurauf N, Michel M, Scherbaum N, Gastpar M, Peters J. Profound Increase in Epinephrine Concentration in Plasma and Cardiovascular Stimulation after [micro sign]-Opioid Receptor Blockade in Opioid-addicted Patients during Barbiturate-induced Anesthesia for Acute Detoxification Anesthesiology. 1998;88(5):1154-1161. doi:10.1097/00000542-199805000-00004 Summarized by Dan Orbidan, OMS3 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42889830

Podcast 1020: Benign Paroxysmal Positional Vertigo (BPPV) 09/07/2026

Podcast 1020: Benign Paroxysmal Positional Vertigo (BPPV) Contributor: Alec Coston, MD Educational Pearls: Benign Paroxysmal Positional Vertigo (BPPV) Common inner ear condition that can cause dizziness Diagnosis of BPPV can help to avoid admissions and extra imaging Three categories: positional, horizontal, and anterior Positional is the most common Dizziness is not a positive indicator, a torsional nystagmus must be induced Dix's hallpike maneuver is done to diagnose and an epley maneuver is then used for treatment Horizontal Usually determined to be the case if the vertigo seems positional and the dix hallpike does not work. A supine roll test would then be done to help diagnose. Instead of a rotational nystagmus, a unilateral horizontal nystagmus is expected. The two patterns are termed geotropic and apogeotropic. Geotropic means the fast phase beats toward the ground, and is treated by a barbeque roll maneuver. Apogeotropic means the fast phase beats toward the ceiling, and is treated by Gufoni maneuver. Anterior is more rare Most cases require neuro consults Determined by attempting to induce a down-beating nystagmus, which is a higher risk nystagmus. Treatment is tilting their head back up in a similar way Inducing the nystagmus is not sided and is more central References You, P., Instrum, R. and Parnes, L. (2019), Benign paroxysmal positional vertigo. Laryngoscope Investigative Otolaryngology, 4: 116-123. Ling X, Zhao D-H, Shen B, Si L-H, Li K-Z, Hong Y, Li Z-Y and Yang X (2020) Clinical Characteristics of Patients With Benign Paroxysmal Positional Vertigo Diagnosed Based on the Diagnostic Criteria of the Bárány Society. Front. Neurol. 11:602. doi: 10.3389/fneur.2020.00602 Rah YC. Advances in Benign Paroxysmal Positional Vertigo: Updated Insights on Diagnostic Pitfalls and Management. J Audiol Otol. 2026 Jan;30(1):1-12. doi: 10.7874/jao.2025.00717. Summarized by Aaryn David | Edited by Aaryn David & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42609830

Podcast 1019: Trauma Blunt Cardiovascular Injuries (BCVI) 08/31/2026

Podcast 1018: Occult Ventricular Fibrillation on Echocardiography 08/24/2026

Podcast 1017: CPR Hand Placement 08/17/2026

Podcast 1016: Hypokalemia 08/10/2026

Podcast 1016: Hypokalemia Contributor: Meghan Hurley, MD Educational Pearls: What is hypokalemia? Hypokalemia is when the measured blood level of potassium falls below 3.5 mEq/L (normal 3.5 - 5.2 mEq/L). Can generally be considered in mild (3.0 - 3.5 mEq/L); moderate (2.5 - 2.9 mEq/L); and severe (<2.5 mEq/L) categories with differing treatment goals based on levels. Should be noted that blood levels of potassium can be low while total body potassium is normal due to intracellular shift by certain agents like β-2 agonists (e.g. Albuterol) or insulin. There is no appreciable loss of insulin despite hypokalemia being present in labs. What are the most common causes of hypokalemia? Medications are a predominant cause; mainly loop and thiazide diuretics. Gastrointestinal losses such as prolonged emesis or diarrhea (can occur in the setting of chronic illness and treatment such as chemotherapy patients with emesis). Other renal losses (e.g. hyperaldosteronism and renal tubular acidosis). A fun-fact renal loss: A compound found in some licorice (Glycyrrhizic acid) can inhibit 11-ß-hydroxysteroid dehydrogenase enzyme type 2 and cause mineralocorticoid excess. See a 2023 case study in references for Lethal Arrhythmia Induced by Licorice. What is a less common cause of hypokalemia? Hypokalemic Periodic Paralysis (HypoPP) is a genetic autosomal dominant channelopathy where patients leak potassium at rest causing a flaccid paralysis of muscle. Typically impacting legs more than arms, and proximal muscles more than distal muscles. Can be triggered carbohydrate rich meals, rest after exercise, febrile illness, and fasting. Male predominance, typically in early adulthood. Treatment is avoidance of triggers and supplementation with conservative oral potassium to avoid overcorrection during attacks. What are some symptoms and findings associated with hypokalemia? Patients may present with generalized weakness and fatigue. Highly crucial to monitor for EKG changes in the setting of hypokalemia. May notice flattening of T wave with the development of a U wave at certain potassium levels. The lower the potassium levels, the more likely a TU fusion can be seen. Prolongs QT interval which puts patients at risk for lethal arrhythmias. What are treatment considerations for hypokalemia? At milder levels of hypokalemia that are asymptomatic and a reversible cause is identified, oral repletion via potassium tablets should be considered. Patients may be a candidate to complete their course of treatment in the Emergency Room. At higher symptomatic levels with distinct EKG changes, more aggressive repletion (including IV Potassium) should be considered. Patients may be candidates for admission. Always monitor and replace magnesium levels as well, as they tend to follow potassium levels as well. Consider intracellular shifts as a source of hypokalemia to avoid risk of overcorrection into hyperkalemia. Hypokalemia can cause deadly heart rhythms such as ventricular fibrillation and ventricular tachycardia including Torsades Des Pointes that will be refractory to defibrillation. Treatment considerations at this point include: Consideration of esmolol Double Sequential Defibrillation Extracorporeal Membrane Oxygenation (ECMO). Key takeaways? Hypokalemia is most often associated with medication side effects or total volume loss from emesis or diarrhea. Depending on the degree of hypokalemia, different treatment considerations must be made. Monitor patient EKG closely for changes that can progress to lethal arrhythmias. References: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020;396(10265):1807-1816. doi: Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. New England Journal of Medicine. 2022;387(21):1947-1956. doi: Oswald S, Ravioli S, Schwarz C, Lindner G. Hypokalaemia in the emergency department: aetiology, diagnosis, and management. Swiss Medical Weekly. 2026;156(4):4767-4767. doi: Gao Z, Xing H, Zhang J, Chen S, Gao Z. Hypokalemic periodic paralysis: novel perspectives from genetic mutations to clinical management. Gene. 2026;999:150172. doi: Han EJ, Park JS. Lethal Arrhythmia Induced by Licorice. J Korean Med Sci. 2023;38(12):e107. doi: Lee YH, Lee KJ, Min YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016;107:150-155. doi: Summarized by Dan Orbidan, OMS3 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42291730

Podcast 1015: Calcium in Hyperkalemia 08/03/2026

Podcast 1015: Calcium in Hyperkalemia Contributor: Meghan Hurley, MD Educational Pearls: What is hyperkalemia? Hyperkalemia is when the measured blood level of potassium reaches above 5.2 - 5.5 mEq/L (normal 3.5 - 5.2 mEq/L). What are common causes of hyperkalemia? Chronic or acute kidney disease. Medications that impact the Renin-Angiotensin-Aldosterone-System (RAAS). Hypoaldosteronism and primary adrenal insufficiency (Addison’s Disease). What are concerns of hyperkalemia? The biggest concern with hyperkalemia is the impact on the cardiac conduction system. At differing levels of hyperkalemia, the patient may initially have peaked T waves, that then progress into a widening of the QRS complex which may eventually lead to a sine wave pattern. This increases risk for cardiac arrest with ventricular fibrillation, PEA, and asystole. What is the treatment algorithm for hyperkalemia? Works through a three-tier approach. First tier treatment is with a calcium agent (calcium gluconate or chloride). Thought for the longest time to “stabilize the cardiac membrane/action potential”. Recent research shows the true mechanism of action is likely through acting on calcium dependent channels. Does not fix underlying hyperkalemia, but buys time for the heart. Second tier treatment is inducing intracellular potassium shift. Can be achieved through agents such as insulin (which may need to be bolused with glucose to prevent hypoglycemia), albuterol, or sodium bicarbonate. Third tier is potassium elimination If the patient is producing urine, loop or thiazide diuretics can be considered. Hemodialysis may also be considered based on patient condition. Long term (and slowest method of elimination) through fecal excretion. Unlikely to see benefits in emergency management. Key Takeaways? Hyperkalemia is a condition that can be brought on by primarily renal conditions and medication side effects. Careful attention must be paid to the patient's cardiac status, and urgent cardiac stabilization (though now we may know that calcium doesn’t truly “stabilize” the cardiac membrane) must be performed to prevent deadly arrhythmias. Definitive management involves addressing the offending agent, offloading potassium, and stabilizing the patient long term. References: Geldermann N, Dzimiera J, Fischer H, Christ M. Acute hyperkalaemia in emergency care: evidence-based approaches. Emerg Med J. 2026;43(5):305-311. doi: Piktel JS, Wan X, Kouk S, Laurita KR, Wilson LD. Beneficial Effect of Calcium Treatment for Hyperkalemia is Not Due to “Membrane Stabilization.” Crit Care Med. 2024;52(10):1499-1508. doi: Hunter RW, Bailey MA. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol Dial Transplant. 2019;34(Suppl 3):iii2-iii11. doi: Summarized by Dan Orbidan, OMS3 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42291670

Podcast 1014: Eating and Drinking on Shift 07/27/2026

Podcast 1014: Eating and Drinking on Shift Contributor; Aaron Lessen, MD Educational Pearls: A 2026 survey asked Canadian emergency medicine (EM) physicians about their eating and drinking habits while on shift. Among 527 respondents, 35% reported that they never or hardly ever ate during shifts, and 37% said the same about drinking water. Lack of time was the most commonly cited barrier, reported by 91% of respondents. Lack of available food, personal health goals, perceived mental clarity, and emergency department culture were also commonly identified factors. Physicians who did not eat or drink on shift often reported that this negatively affected their work. Years in practice were associated with eating more often while on shift, suggesting that newer physicians may be less likely to eat during shifts. A 2023 study by Kontrick et al. found that 89% of US-based EM residency programs did not have a dedicated meal break, which may help explain why early-career physicians are less accustomed to eating during clinical shifts. Studies outside of emergency medicine have also suggested that inadequate food and fluid intake can affect fatigue, mood, attention, and cognitive performance, though direct evidence in emergency department physicians and patient care remains limited. Future studies could examine whether physician eating and drinking habits during shifts are associated with patient outcomes and broaden the scope of this study to other emergency department providers, nurses, and technicians. References: Farquhar, Madeleine et al. “A lot on their plates? Examining the on-shift eating and drinking habits of Canadian emergency medicine physicians.” CJEM vol. 28,1 (2026): 64-73. doi:10.1007/s43678-025-01044-8 Kontrick, Amy V et al. “Do emergency medicine residents have access to healthy food options during work hours?.” AEM education and training vol. 7,4 e10890. 17 Jul. 2023, doi:10.1002/aet2.10890 Lemaire, Jane B et al. “Physician nutrition and cognition during work hours: effect of a nutrition based intervention.” BMC health services research vol. 10 241. 17 Aug. 2010, doi:10.1186/1472-6963-10-241 Wittbrodt, Matthew T, and Melinda Millard-Stafford. “Dehydration Impairs Cognitive Performance: A Meta-analysis.” Medicine and science in sports and exercise vol. 50,11 (2018): 2360-2368. doi:10.1249/MSS.0000000000001682 Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42217200

Podcast 1013: Thoracotomy Indications 07/20/2026

Podcast 1013: Thoracotomy Indications Contributor; Taylor Lynch, MD Educational Pearls: Thoracotomy Thoracotomy is used in traumatic cardiac arrest to replace conventional CPR with direct access to the chest. Goals include identifying and controlling reversible causes of bleeding, prioritizing blood flow to the heart and brain, and performing open cardiac massage. Trauma categories Penetrating trauma: Gunshot wounds and stab wounds. Has a higher chance of survival because the injury may be localized and directly repairable. Cardiac stab wounds may have the highest survivability because the defect can be visualized, repaired, and treated with blood administration. Blunt trauma: Motor vehicle collisions and falls from height. Has a much lower chance of survival. Western guidelines EMS must witness the patient lose pulses. Penetrating trauma: CPR for less than 15 minutes. Blunt trauma: CPR for less than 10 minutes. Survival decreases to essentially zero beyond these time limits. Eastern guidelines Focus on the presence of signs of life in blunt or penetrating trauma. Signs of life may include: Pupillary response. Measurable blood pressure. Purposeful movement. Patient selection Thoracotomy should only be performed when the patient has a reasonable chance of survival. It is a highly morbid procedure with significant occupational risks, including needlestick injury. Appropriate patient selection and timing are essential. Procedure Begin on the left side of the chest. Cross-clamp the aorta to restrict blood flow below the heart and prioritize circulation to the heart and brain. Identify and repair visible sources of bleeding involving structures such as the heart or lungs. Perform open cardiac massage as the equivalent of CPR. ACLS medications may still be administered. References: Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006;1:4. Published 2006 Mar 24. doi:10.1186/1749-7922-1-4 Rhee, Peter M. ; Acosta, Jose ; Bridgeman, Amy et al. / Survival after emergency department thoracotomy : Review of published data from the past 25 years. In: Journal of the American College of Surgeons. 2000 ; Vol. 190, No. 3. pp. 288-298. Nunn, Andrew ; Prakash, Priya ; Inaba, Kenji et al. / Occupational exposure during emergency department thoracotomy : A prospective, multi-institution study. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 78-84. Burlew CC, Moore EE, Moore FA, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359-1363. doi:10.1097/TA.0b013e318270d2df Seamon MJ, Haut ER, Van Arendonk K, et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;79(1):159-173. doi:10.1097/TA.0000000000000648 Summarized by Steven Fujaros NREMT | Edited by Steven Fujaros & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/42143440

Podcast 1012: Meth Sedation 07/13/2026

Podcast 1011: Creepy Crawlies 07/06/2026

Podcast 1011: Creepy Crawlies Contributor: Meghan Hurley, MD Educational Pearls: What animal is the most lethal to humans? Depending on how we define lethal, and animal, this answer is actually not straight forward. Globally and in the U.S. the most lethal animal is humans, accounting for ~436,000 to ~20,000 deaths (homicides) per year on average respectively. In the United States the most lethal animal is of the Hymenoptera order (bees, wasps, and hornets). It accounts for approximately ~60 deaths per year from anaphylaxis. Globally the number is harder to track, but is estimated between 250–3,800 deaths globally annually. Globally the most lethal animal is venomous snakes, accounting for between 60,000-150,000 per year (whereas in the United States this number is closer to ~5). Mosquitos, as a vector however for the pathogens they transmit, out rank all as the most lethal globally (excluding humans). What are the key take-aways for each insect discussed in this episode? Mosquitos: In the United States, of lesser concern. Can potentially transmit West Nile Virus in the United States. Otherwise, treatment for general mosquito bites is topical antihistamines and over the counter steroid creams. Hymenoptera order (bees, wasps, and hornets): Distributed throughout the US, and can also live in the ground. Bees lose their stinger during a sting. Whereas wasps do not and can sting multiple times. Typically stings are just localized for symptoms (pain and swelling) but can become anaphylactic. Treat with IM Epinephrine as the first line. Consider bronchodilators from bronchospasms. Multiple stings (around ~100), can cause end organ damage and rhabdomyolysis outside of just anaphylaxis alone. Require more aggressive management. Fire Ants: Behave similar to bees (in swarm mentality), but have differing venoms. Can also cause global symptoms. Black Widow: No deaths from Latrodectus hesperus (Western Black Widow) recorded in the United States. There are 3 deaths globally from widow species. Two from Madagascar, and one from a Mediterranean species of widow. Debate in the toxicology community about use of the antivenom, which may account for more deaths than the bite itself. Black Widow bites are typically painful. Which is different from bites from recluse species. Brown Recluse: Rare in Colorado Typically painless bite, that creates a center necrotic eschar. Tend to also not be lethal. Bed Bugs Typically harmless and more of a nuisance to have. Can cause localized infections. Bite presents in a “Breakfast, Lunch, and Dinner” formation (i.e. linear 2-3 or more bites as the bug tracks and feeds on skin). Will feed primarily on exposed skin. The biggest concern is ensuring no cross contamination from patient to provider or facility. Bed bug bite delivers a small amount of local anesthetic, which can make them hard to detect. References Haskell MG, Langley RL. Animal-Encounter Fatalities, United States, 1999-2016: Cause of Death and Misreporting. Public Health Rep. 2020;135(6):831-841. doi: Herness J, Snyder MJ, Newman RS. Arthropod Bites and Stings. AFP. 2022;106(2):137-147. GBD 2019 Snakebite Envenomation Collaborators. Global mortality of snakebite envenoming between 1990 and 2019. Nat Commun. 2022;13(1):6160. doi: Wei YL, Wu Z, Li RL, Tang F. Review of selected mosquito-borne diseases: arboviruses (dengue, chikungunya, Zika, West Nile, Japanese encephalitis, yellow fever) and parasitic diseases (malaria, lymphatic Filariasis). Front Public Health. 2025;13:1712094. doi: Forsberg K, Sheats KJ, Blair JM, et al. Surveillance for Violent Deaths - National Violent Death Reporting System, 50 States, the District of Columbia, and Puerto Rico, 2022. MMWR Surveill Summ. 2025;74(5):1-42. doi: Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41966300

Podcast 1010: First Pass Intubation Success 06/29/2026

Podcast 1010: First Pass Intubation Success Contributor: Travis Barlock, MD Educational Pearls: First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma. Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt How to improve likelihood of first-pass success: Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71% Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without Use a Checklist mnemonic (SOAPME) Suction – On, ready, and within reach Oxygen – Patient is preoxygenated Adjuncts – Oral/nasal adjuncts and BVM ready Positioning - Patient positioned properly; consider obesity, using semi-Fowler/head-up positioning Medications – Rapid sequence intubation (RSI), sedation, vasopressor, and other medications prepared as necessary Equipment – Laryngoscope (blade), tube, bougie/stylet, syringe, scalpel/cric kit, others ready as necessary References Sakles, J.C., Chiu, S., Mosier, J., Walker, C. and Stolz, U. (2013), The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med, 20: 71-78. https://doi.org/10.1111/acem.12055 Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine. 2023;389(5). doi:https://doi.org/10.1056/nejmoa2301601 Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179–2189. doi:10.1001/jama.2018.6496 ‌Turner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001/jamanetworkopen.2020.9278 Turner, Joseph S et al. “Feasibility of upright patient positioning and intubation success rates At two academic EDs.” The American journal of emergency medicine vol. 35,7 (2017): 986-992. doi:10.1016/j.ajem.2017.02.011 Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41853870

On the Streets- Zero to Rodeo 06/22/2026

Carepoint Journal Club- Neurology 06/15/2026

Podcast 1009: Prevention for Recurrent UTI 06/08/2026

Podcast 1009: Prevention for Recurrent UTI Contributor: Aaron Lessen, MD Educational Pearls: UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment. UTI signs and symptoms Burning sensation when urinating Strong urge to urinate Urinating often and passing small amounts of urine. Pelvic pain There are currently more guidelines and studies on treatments to prevent these recurrent UTIs in women that we can start in the Emergency Department. Vaginal estrogen has been shown to significantly reduce this issue of recurrence. Very simple prescriptions can be prescribed in the ED It has little systemic absorption and is generally very safe and effective. References Wells BA, De EJB, Visingardi J, Feustel PJ. IP15-36 IMPACT OF VAGINAL ESTROGEN ON SERIOUS ADVERSE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY. Journal of Urology [Internet]. 2025 May 1;213(5S):e778. Available from: https://doi.org/10.1097/01.JU.0001109984.67114.74.36 Ackerman AL, Bradley M, D’Anci KE, Hickling D, Kim SK, Kirkby E. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). J Urol. 0(0). doi: 10.1097/JU.0000000000004723 Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589 Meister MR, Wang C, Lowder JL, Mysorekar IU. Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e39-e44. doi: 10.1097/SPV.0000000000000790. PMID: 31725016; PMCID: PMC7737516. Nazarko L. Recurrent lower urinary tract infection in older women [Internet]. Urology & Continence Care Today. Available from: https://www.ucc-today.com/journals/issue/launch-edition/article/recurrent-lower-urinary-tract-infection-in-older-women-ucct Summarized by Aaryn David & Ahmed Abdel-Hafiz | Edited by Aaryn David & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41564500

Podcast 1008: Acupuncture for Low Back Pain in Older Adults 06/01/2026

Podcast 1008: Acupuncture for Low Back Pain in Older Adults Contributor: Aaron Lessen, MD Educational Pearls: Back pain is a common presenting complaint in the emergency department. Challenges arise when tailoring care to elderly populations using standard medical therapy: Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion. Pain medications such as opiates have side effects including constipation, respiratory depression, and hypotension. NSAIDs carry a risk of GI bleeding and worsening kidney function with chronic use. A randomized clinical trial assessing the effects of acupuncture on low back pain took 800 adults aged 65 and older with chronic low back pain and placed them into one of three treatment arms: Usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus 4-6 maintenance sessions during the next 12 weeks, plus usual medical care Using the Roland-Morris Disability Questionnaire (RMDQ) score, they assessed disability at 6 months and 12 months. The study found that those who had undergone treatment with acupuncture had significantly greater improvements in disability related to low back pain compared to the group that was only treated with usual medical care. Acupuncture is not used in the ER, but could represent a relatively safe adjunctive therapy for patients who are not responding to standard medical therapy alone. References: American College of Surgeons Committee on Trauma. Best practices guidelines: geriatric trauma management. American College of Surgeons; 2023. Accessed May 27, 2026. DeBar LL, Wellman RD, Justice M, et al. Acupuncture for chronic low back pain in older adults: a randomized clinical trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P /episode/index/show/emergencymedicalminute/id/41483930

Podcast 1007: Caffeine Pharmacology 05/25/2026

Podcast 1007: Caffeine Pharmacology Contributor: Travis Barlock, MD Educational Pearls: Caffeine Geography and Types: Caffeine is found throughout the world and has evolved independently in various plants that are not evolutionarily related through direct lineage, but rather demonstrate convergent evolution (i.e. different species evolve the same traits). These plants use caffeine as an insecticide. Examples of caffeine sources include coffee, tea, yerba-mate, guaraná, cacao, and yaupon holly. Roughly 85% of Americans are estimated to consume caffeine daily. Caffeine Pharmacology in Humans: In humans, caffeine is a nonselective competitive antagonist (blocker) of adenosine receptors (A1 and A2A). During waking hours, neuronal metabolic activity consumes ATP, and a byproduct of ATP hydrolysis is created: adenosine. Adenosine proceeds to build a “sleep pressure”. Acting on A1 and A2A adenosine receptors to induce sleep (on A1, it suppresses neuronal “wakefulness” and on A2A it is believed to be an inducer of sleep). Caffeine, by blocking those receptors, blunts sleep induction and feelings of being tired. Caffeine has a half-life of around 6 hours, and a quarter life of approximately 12 hours, which is when the caffeine will off-load and adenosine can once again occupy those receptors, potentially causing a “crash”. Thus, for shift-workers, it is important to time caffeine intake roughly 10 hours before target bed time. Caffeine exerts other effects on the body. It is methylxanthine similar to theophylline, which works as a bronchodilator (via phosphodiesterase and adenosine pathways). Caffeine has clinical use to promote bronchodilation in pre-term infants. Caffeine exerts diuretic effects as well (blocking proximal renal tubule reabsorption). Recent ingestion of caffeine may blunt therapeutic use of adenosine in patients with SVT. Key Takeaway? Caffeine exerts a wide variety of effects beyond making us feel more awake. It has cardiovascular, pulmonary, and renal implications in its pharmacodynamics. References Benarroch EE. Adenosine and its receptors: multiple modulatory functions and potential therapeutic targets for neurologic disease. Neurology. 2008;70(3):231-236. doi: Mitchell DC, Knight CA, Hockenberry J, Teplansky R, Hartman TJ. Beverage caffeine intakes in the U.S. Food Chem Toxicol. 2014;63:136-142. doi: Bruschettini M, Brattström P, Russo C, Onland W, Davis PG, Soll R. Caffeine dosing regimens in preterm infants with or at risk for apnea of prematurity - Bruschettini, M - 2023 | Cochrane Library. Accessed May 23, 2026. Huang R, O’Donnell AJ, Barboline JJ, Barkman TJ. Convergent evolution of caffeine in plants by co-option of exapted ancestral enzymes. Proc Natl Acad Sci U S A. 2016;113(38):10613-10618. doi: Cabalag MS, Taylor DM, Knott JC, Buntine P, Smit D, Meyer A. Recent caffeine ingestion reduces adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia. Acad Emerg Med. 2010;17(1):44-49. doi: Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41412040

Podcast 1006: Cannabinoid Pharmacology 05/18/2026

Podcast 1006: Cannabinoid Pharmacology Contributor: Travis Barlock, MD Educational Pearls: Endocannabinoid System: THC binds CB1 and CB2 receptors in neurons and immune cells Δ9-Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis CB1 and CB2 receptors typically bind endogenously-produced 2-arachidonoylglycerol (2-AG) and anandamide (AEA) to regulate pain, stress, and inflammation THC similarly binds CB1 and CB2, leading to the cannabinoid high: euphoria, paranoia, anxiety, analgesia, anti-inflammation, and appetite, among a variety of others Ingestion via edibles, vice inhalation via smoking, leads to chemical modification of Δ9-THC to 11-hydroxy-Δ9-THC, which more easily crosses the blood-brain barrier and binds CB1 with higher affinity, leading to increased psychoactivity Cannabinoid Hyperemesis Syndrome (CHS): Chronic THC use leading to the classic presentation of persistent nausea and intense, frequent vomiting Chronic activation of CB1 receptors in brain builds a tolerance and dependence on THC, in addition to chronic activation of the capsaicin and vanilloid receptor TRPV1, which binds capsaicin or is activated by heat Treatment by warm showers works due to TRPV1 activation by heat Treated with benzodiazepines, fluids, and gastro-intestinal or central nervous system agents according to patient presentation Over 200 synthetic cannabinoids have been created (K2, spice, black mamba, mojo, etc), which are more dangerous and can lead to a variety of etiologies Acetaminophen binds CB1 receptors to reduce inflammatory pain References Loganathan P, Gajendran M, Goyal H. A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome. Pharmaceuticals (Basel). 2024;17(11):1549. Published 2024 Nov 18. doi:10.3390/ph17111549 Wall ME, Sadler BM, Brine D, Taylor H, Perez-Reyes M. Metabolism, disposition, and kinetics of delta-9-tetrahydrocannabinol in men and women. Clin Pharmacol Ther. 1983 Sep;34(3):352-63. doi: 10.1038/clpt.1983.179. PMID: 6309462. Mills B, Yepes A, Nugent K. Synthetic Cannabinoids. Am J Med Sci. 2015 Jul;350(1):59-62. doi: 10.1097/MAJ.0000000000000466. PMID: 26132518. Klinger-Gratz PP, Ralvenius WT, Neumann E, et al. Acetaminophen Relieves Inflammatory Pain through CB1 Cannabinoid Receptors in the Rostral Ventromedial Medulla. J Neurosci. 2018;38(2):322-334. doi:10.1523/JNEUROSCI.1945-17.2017 Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41325495

Podcast 1005: Balanced Fluid vs Normal Saline in Pediatric Patients 05/11/2026

Carepoint Journal Club: Occlusion Myocardial Infarction 05/07/2026

Podcast 1004: Sinus Arrest Post TAVR 05/04/2026

Podcast 1004: Sinus Arrest Post TAVR Contributor: Taylor Lynch, MD Educational Pearls: Conduction abnormalities are a common and clinically significant complication in patients who undergo transcatheter aortic valve replacement (TAVR) Clinical Features The most common abnormalities include high grade AV block and new onset LBBB Due to the close proximity of the aortic annulus to the AV node and His-Purkinje system More common in males, the elderly, and those with pre-existing conduction disease (RBBB or LBBB) Sinus pauses and sinus arrest are a rare post-TAVR rhythm disturbances Temporary failure of sinus node firing with absent P waves, followed by return of sinus rhythm Sinus Pauses: Typically last < 3 seconds Sinus Arrest: Typically last > 3 seconds Not due to direct mechanical injury from the valve, but may occur in patients as a result of pre-existing disease or other external factors: Medications Beta blockers, calcium channel blockers, digoxin Pre-existing damage to the SA node Fibrosis from a previous MI Treatment If the patient is asymptomatic, provide ongoing surveillance If the patient is symptomatic, treatment should be aimed at the underlying cause: For medication-induced abnormalities, stop the offending medication For acute, unstable bradycardia: Medications: Atropine, Dopamine Infusion, Epinephrine Infusion If cardiology is not immediately available, initiate transcutaneous pacing or insert a temporary transvenous pacemaker Definitive treatment: Pacemaker ~10–15% of patients may develop a bradyarrhythmia post TAVR, with ~8-15% later requiring a pacemaker Due to the risk of conduction abnormalities post TAVR, many patients are discharged with ambulatory rhythm monitoring such as a ZioPatch or Holter monitor, and may present to the emergency department for evaluation of rhythm disturbances. References: Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm. 2019;16(9):e128-e226. Lilly, S, Deshmukh, A, Epstein, A. et al. 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. 2020 Nov, 76 (20) 2391–2411. Sammour, Y, Krishnaswamy, A, Kumar, A. et al. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol Intv. 2021 Jan, 14 (2) 115–134. https://doi.org/10.1016/j.jcin.2020.09.063 Tarakji KG, Patel D, Krishnaswamy A, et al. Bradyarrhythmias detected by extended rhythm recording in patients undergoing transcatheter aortic valve replacement (Brady-TAVR Study). Heart Rhythm. 2022;19(3):381-388. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41129310

Podcast 1003: Nasal Intubation 04/27/2026

Podcast 1003: Nasal Intubation Contributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point for the ETT (nare v.s. mouth). Nasal Intubations are seldom preferred to oral intubations as they carry risk for inducing bleeding from trauma to the nasal passages. Indications for nasal intubations include: Anatomical abnormalities that may make access through the mouth difficult (i.e. tumors, macroglossia, or rare dental hardware that clenches the jaw shut). Physiological states such as severe angioedema. Nasal intubations are often done with the patient awake and could be advantageous if the patient is presenting in a severely hypoxic state such that prolonged hypoxia in a traditional RSI protocol may be detrimental. A 2023 retrospective analysis in Germany found that nasal intubations were associated with requiring less sedation than oral intubations and had more spontaneous breathing during hospitalization than oral intubations. How is a nasal intubation performed? Consider the use of an anxiolytic medication such as versed to calm the patient down but not fully sedate them. If there is adequate time without immediate patient compromise, consider glycopyrrolate to reduce airway secretions and dry up the mucous membranes. Consider the use of Afrin or other local vasoconstrictor in target nare to minimize epistaxis. Use 5% lidocaine ointment and lubricate an NPA and place it into the target nare. This will allow for local anesthesia as well as help to open up the nare slightly more. Take 5% lidocaine ointment and place it on a tongue depressor and move it around the back of the tongue, allowing it to further anesthetize the oropharynx. Remove the NPA and atomize/nebulize 4% lidocaine liquid into the nare and into the oropharynx for further anesthesia. Insert the ETT without the bronchoscope through the nare and allow it to pass about 10 cm until visible in the oropharynx. This allows for a “clean” plastic tunnel to pass the bronchoscope through. Advance both the ETT and bronchoscope, spraying lidocaine through the bronchoscope while advancing to allow for continued numbing. Pass the ETT through the cords and inflate. At this point, stronger sedation medications such as ketamine and propofol may be considered but the use of a paralytic like succinylcholine and rocuronium may not be needed to allow the patient to maintain their own negative pressure ventilation. Which nare is the best to go through? Most patients will have their right nare be the best (away from the septal deviation) according to a meta-analysis by Tan et al. The right nare was generally associated with less epistaxis and lower intubation times. However, do not always default to the right nare, and test which nare is more patent by occluding one nare at a time and assessing which one is less resonant (less resonant = more patent). Key Takeaway? Nasal intubations are rarer than oral intubations and can be more technically difficult, but may offer advantages in patients with difficult oral airways, but should never be first line. References: Grensemann J, Gilmour S, Tariparast PA, Petzoldt M, Kluge S. Comparison of nasotracheal versus orotracheal intubation for sedation, assisted spontaneous breathing, mobilization, and outcome in critically ill patients: an exploratory retrospective analysis. Sci Rep. 2023;13:12616. doi: Tan YL, Wu ZH, Zhao BJ, Ni YH, Dong YC. For nasotracheal intubation, which nostril results in less epistaxis: right or left?: A systematic review and meta-analysis. Eur J Anaesthesiol. 2021;38(11):1180-1186. doi: Holzapfel L. Nasal vs oral intubation. Minerva Anestesiol. 2003;69(5):348-352. Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/41026260

Podcast 1002: Elder Agitation 04/20/2026

Podcast 1002: Elder Agitation Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder. What environmental changes can help reduce agitation? Maintain a quiet, calm, uncluttered environment Dim the lights Ensure the patient has their glasses, hearing aids, and dentures Avoid excessive lines such as foleys Minimize restraints and other forms of immobilization Reassure the patient frequently and have the family check in with the patient What are the best options if medications are required? If the patient is unsafe or non-pharmacologic measures fail, consider a second-generation (“atypical”) antipsychotic using the lowest effective dose: Olanzapine Risperidone Quetiapine One special consideration is Dementia with Lewy Bodies, which can be very sensitive to antipsychotics. In this case, Quetiapine is the preferred agent. Avoid when possible: Diphenhydramine and other anticholinergics, which can worsen delirium (including urinary retention and sedation) Benzodiazepines, which may worsen confusion, falls, and respiratory depression Haloperidol, which has a higher risk of extrapyramidal symptoms and QT prolongation than many atypicals References Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol. 2022 May;35(3):255-261. doi: 10.1177/0891988720988916. Epub 2021 Jan 19. PMID: 33461372. Kurlan R, Cummings J, Raman R, Thal L; Alzheimer's Disease Cooperative Study Group. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology. 2007 Apr 24;68(17):1356-63. doi: 10.1212/01.wnl.0000260060.60870.89. PMID: 17452579. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb;75(2):136-145. doi: 10.1016/j.annemergmed.2019.07.023. Epub 2019 Sep 26. PMID: 31563402; PMCID: PMC7945005. Summarized and edited by Jeffrey Olson, MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf /episode/index/show/emergencymedicalminute/id/40931460

Podcast 1001: Acute Intermediate Risk Pulmonary Embolism 04/13/2026

Podcast 1001: Acute Intermediate Risk Pulmonary Embolism Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized controlled trial evaluated treatment of intermediate risk PE patients Patients were randomized to receive either thrombectomy with anticoagulation or anticoagulation alone The primary outcome evaluated changes in right ventricular enlargement at 48 hours A controversial primary outcome because it does not speak to mortality or incidence of other necessary aggressive interventions Low clinical significance The study found that thrombectomy significantly reduced right ventricular enlargement faster than anticoagulation alone. However, there was no statistical difference in mortality or need for other treatments Treatment for intermediate risk PE patient remains controversial The same study will have second follow-up at 90 days to see if there are other benefits References Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/ /episode/index/show/emergencymedicalminute/id/40823155

Celebrating 1000 Medical Minutes 04/03/2026

Celebrating 1000 Medical Minutes Hosts: Don Stader, Nate Novotny, Travis Barlock, and Jeffrey Olson In this episode, we reminice about the first 1000 medical minutes presented by EMM and what the next 1000 might hold. Below are all of the episodes referenced in this episode. Please go back and give them all a listen. Segment 1- Recap and Facts 1st medical minute o April 29, 2016. Almost exactly 10 years ago. o Diverticulitis and Antibiotics by Dr. Chris Holmes 1000th Medical Minute o March 30, 2026 o Treatment of burns by Aaron Lessen o Edited by Ashley Lyons and published by Jorge Chalit Favorite sub-topics have included: o Cardiovascular topics- 150 episodes o Pharmacology- 97 episodes o Toxicology- 85 episodes o Neurology- 75 episodes The "Hunting for…" cinematic universe. -Michael Hunt o 399: Hunting for Pancreatitis o 424: Hunting for Measles o 432: Hunting for UTIs o 445: Hunting for the Endotracheal Tube o 455: Hunting for PeeCP o 460: Hunting for PE in Syncope o 487: Hunting for Epiglottitis Obsession with 1966- Chris Holmes o 120: The State of Sepsis in 1966 o 125: Old School CPR - 1966 o 138: Bromide Toxicity - 1966 o 147: GI Bleed - 1966 o 675: CHF like it's 1966 Favorite drug: naloxone/narcan (9) o 7: Heroin Overdose and OTC Narcan o 464: Narcan't? o 516: Narcan and Pulmonary Edema o 931: Naloxone in Cardiac Arrest Favorite disease state: Sepsis (13) o 22: Sepsis Sofa o 219: History of Sepsis o 244: Fever in Sepsis o 263: Early Antibiotics in Sepsis o 272: More on Temperature in Sepsis o 287: Sepsis Bundles o 544: C is for Sepsis Unhinged title combinations o 84: Hypothermia and Lightning Strike: Code Blue o 203: Wine, Milk and… Vaccines!? o 216: Roller Coasters and Kidney Stones o 299: Black Death, Lice, Math, and Pottery o 427: Cookie Dough is Delicious o 670: Operation Tat-Type o 695: Einstein and Cellophane o 777: Grass, weed and ancient Rome o 781: Foxglove, dropsy, and Salvador Dali o 959: The KLM Flight Disaster and Lessons in Healthcare Communication Most frequent contributors - Aaron Lessen- 192 - Don Stader- 84 - Jarod Scott- 83 - Peter Bakes- 53 - Samuel Killian- 45 - Dylan Luyten- 41 - Erik Verzemnieks- Dozens - Michael Hunt- 34 - Travis Barlock- 30 - Ricky Dhaliwal- 25 Top female voices o Rachael Duncan, PharmD o Rachel Beham, PharmD o Meghan Hurley o Gretchen Hinson o Suzanne Chilton o Katie Sprinkle Most listened to - 8. Podcast 835: Syncope Review - 7. Podcast 766: Truth about Tramadol - 6. Podcast 839: Causes of Pancreatitis - 5. Podcast 760: Why Fentanyl is the Worst - 4. Podcast 844: Dental Infections - 3. Podcast 846: Early Repolarization vs. Anterior STEMI - 2. Podcast 845: Hyperkalemic Cardiac Arrest - 1. Podcast 847: ECMO CPR Mini-game: who has actually seen our most rare diagnoses? o 18: Lemierre's Syndrome – Septic thrombophlebitis of the internal jugular vein after oropharyngeal infection leading to septic emboli. o 139: Locked-in Syndrome – Ventral pontine lesion causing quadriplegia and inability to speak with preserved consciousness and eye movements. o 144: Moyamoya Disease – Progressive stenosis of intracranial carotids with development of fragile collateral vessels causing strokes. o 221: Cotard Delusion (Walking Corpse Syndrome) – Psychiatric disorder where patients believe they are dead or do not exist. o 240: Pott’s Puffy Tumor – Frontal bone osteomyelitis with subperiosteal abscess from sinusitis causing forehead swelling. o 277: Mucormycosis (Rhizopus) – Angioinvasive fungal infection in immunocompromised patients causing rapid tissue necrosis. o 293: Transient Global Amnesia – Sudden, transient loss of ability to form new memories that resolves within 24 hours. o 329: Hypokalemic Periodic Paralysis – Episodic muscle weakness due to intracellular potassium shifts. o 374: Iliac Artery Endofibrosis – Exercise-induced fibrosis of the iliac artery causing claudication in athletes. o 466: Subacute Sclerosing Panencephalitis (SSPE) – Progressive, fatal neurodegenerative disease from persistent measles infection. o 477: Postpolypectomy Electrocoagulation Syndrome – Transmural burn of the colon after polypectomy causing localized peritonitis without perforation. o 578: Brown-Séquard Syndrome – Hemisection of the spinal cord causing ipsilateral motor/proprioception loss and contralateral pain/temperature loss. o 697: Kounis Syndrome – Acute coronary syndrome triggered by allergic reaction causing coronary vasospasm or plaque rupture. o 973: Meningitis Retention Syndrome – Acute urinary retention due to sacral nerve dysfunction during meningitis. Segment 2- Individual Interviews Segment 3- Looking forward Segment 4- Trivia Podcast 38, what is significant about diphtheria and March 18th? o On March 18th, the Iditarod is run in Alaska to commemorate a sled dog team, led by Balto, that ran from Nome to Anchorage and back to provide children in Nome with the diphtheria anti-toxin serum. Podcast 52: Syphilis the Great Imitator. The study of Syphilis or “Syphilology” evolved into the field of what? o Dermatology Podcast 121: The Poor Man’s Methadone. What is the poor man’s methadone? o Imodium Podcast 136: James Lind, conducted the first clinical trial in 1747 and proved that what cure what? Hint: think vitamins. o Citrus fruits cure scurvy. Podcast #213: --- and Potatoes. What food has been shown to lower LDL? o Oats Podcast #216: Roller Coasters and Kidney Stones. A study used a model of a kidney and ureter with different sized stones and put it on ------ roller coaster in Disney World. o Thunder Mountain Podcast #261. ---- was introduced to treat ACE-inhibitor induced angioendema. but later, better-powered studies showed that it had no benefit compared to standard treatment. o Icatibant Podcast #304: ---. ---- was a formal medical diagnosis, and one that dates back to 17th century when soldiers had longing for home and melancholy with a constellation of symptoms including lethargy, sadness, disturbed sleep, heart palpitations, GI complaints, and/or skin findings for which the only cure was to return home. o Nostalgia Podcast # 351: Steakhouse Syndrome. What is steakhouse syndrome? o Impacted food bolus 2/2 esophageal stricture Podcast # 362: Giant Hogweed. What can Giant Hogweed cause. o Photosensitivity, severe blisters, and burns Podcast #398: Who is gonna fail your antibiotic plan? What vital sign abnormality at triage had the highest odds ratio for treatment failure for the treatment of cellulitis with antibiotics. o Tachypnea Podcast # 458: A Tylenol a Day Keeps the ---- Away? A recent study investigated the effect of scheduled IV acetaminophen on the incidence of ---- in post-CABG patients in the ICU o Delerium Podcast 554: Sleeping Away Alzheimer’s. What is the difference between white noise and pink noise? o White noise is all the surrounding sound frequencies mixed together that your brain tunes down so you don’t get distracted while you're sleeping o Pink noise, or deep soothing noises, is the accentuated bass sounds like falling rain or waves crashing your brain keys into while sleeping. o Pink noise during sleep has been shown to increase stage 4, creating more CSF washout of beta amyloid. Podcast 580: Origin of PPE. Why were rubber gloves invented? o 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. Podcast 587: Puppies Preventing Burnout? Puppies lower stress, what activity in that study increased stress? o Coloring, because they were denied a chance to play with a puppy Podcast 596: Weather Can be a Headache. What are the three weather events that can increase the frequency of headaches? o High temp o Low humidity o High air pollution Podcast 612: Origin of Vaccines. Guess both diseases. The potential of vaccinations was first observed in the late 1600s when Jenner observed people who had cowpox never contracted ----. Years later, Louis Pasteur inoculated chickens with ---- after his assistant accidently created the first live attenuated vaccine by creating a weakened bacteria when he left the bacteria out while he went on vacation o Smallpox, cholera Podcast 670: Operation Tat-Type. In 1951, Operation Tat-Type began tattooing adults with their ---- in an effort to prepare for ---- in the time of the Cold War and the Korean War o Blood type, rapid transfusions Podcast 695: Einstein and Cellophane. Albert Einstein had ----- as a middle-aged man. Dr. Rudolph Nissen, founder of the Nissen fundoplication, performed exploratory surgery for this pain and found a ---- - The only treatment for an AAA at that time was to----, causing a fibrotic response to prevent rupture - Einstein died 7 years after this surgery, likely from his leaking abdominal aortic aneurysm o chronic abdominal pain o AAA o wrap the vessel in cellophane Podcast 748: -----. Whale blubber, honey, home fermented foods, homemade wine (especially the wine made in prison), and improperly stored canned food can all contain the toxin o Botulism Podcast 777: Grass, Weed, and Ancient Rome. Wine and wormwood and white hellborn were used in ancient rome to treat ----. o Nausea, sea sickness Podcast 821: EKGs in Syncope. Travis suggests a mnemonic for remembering additional EKG findings to look for in syncope o WOBBLER § Wolff-Parkinson-White (WPW) § Obstructed AV node § Brugada syndrome § Bifascicular block § Left Ventricular Hypertrophy (LVH) § Epsilon waves § Repolarization abnormalities Podcast 890: Outdoor Cold Air for Croup A 2023 study, published in the Journal of Pediatrics, investigated whether a 30-minute exposure to outdoor cold air could improve mild to moderate croup symptoms before the onset of steroid effects. In what country was this study conducted. o Switzerland Podcast 925: Pediatric Tongue Entrapment. Case study of a peds patient with his/her tongue stuck in a drinking cap. What was the substance that finally set it free? o Table sugar Podcast 960: Frank’s Sign - A Marker for Coronary Artery Disease. What is Frank’s Sign? o Bilateral earlobe crease Thank you to all that make the EMM awesome! Hosted and editted by Jeffrey Olson MS4 | Additional editting by Jorge Chalit, OMS4 Donate: Join our mailing list: /episode/index/show/emergencymedicalminute/id/40720615

Podcast 1000: Cool Water 03/30/2026

Emergency Medical Minute

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