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PODCAST

Emergency Medical Minute

Emergency Medical Minute

Our near daily podcasts move quickly to reflect current events, are inspired by real patient care, and speak to the true nature of what it"s like to work in the Emergency Room or Pre-Hospital Setting. Each medical minute is recorded in a real emergency department, by the emergency physician or clinical pharmacist on duty – the ER is our studio and everything is live.

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All Episodes

04:54

Podcast 844: Dental Infections

Emergency Medical Minute ·

2023/01/10

Contributor: Meghan Hurley, MD Educational Pearls: Educational Pearls: Dental infections can be categorized into two main groups Infections of the gums Pericoronitis Tooth eruption leading to inflammation/irritation Can progress to an infection Requires pain control, no antibiotics Gingivitis Inflammation of the gums Can lead to an infection requiring antibiotics Abscess (gums) If an infection develops in the gums it can progress to an abscess May require drainage Acute necrotizing

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04:50

Podcast 843: Commotio Cordis

Emergency Medical Minute ·

2023/01/09

Contributor: Jared Scott, MD Educational Pearls: Commotio cordis is sudden ventricular fibrillation precipitated by direct impact to the chest A national registry, US Commotio Cordis Registry, reports an average of 10-20 cases annually 95% of reported cases occur in males, indicating possible genetic component Average age of patient in registry is 15 Most cases occur during sporting events (baseball in particular), in addition to physical altercations and industrial accidents Treatment is

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04:25

Podcast 842: “History of Wound Care”

Emergency Medical Minute ·

2023/01/04

Contributor: Chris Holmes, MD Educational Pearls: Through world history, there have been various interesting approaches to wound care Ancient Egyptians applied honey, lint, and grease which provided antimicrobial, absorptive and moisturizing properties, respectively Ancient Greeks irrigated wounds with clean water and applied wine and vinegar which may have been antimicrobial One of the first synthetic topical antimicrobials was a dye researched by scientist Gerhard Domagk and later produced by

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03:02

Podcast 841: Wound Care

Emergency Medical Minute ·

2023/01/03

Contributor: Aaron Lessen, MD Educational Pearls: Wound care in the emergency department aims to prevent future infection Copious wound irrigation is the important step in preventing wound infection Studies have shown that irrigation with tap water is just as effective, if not superior, to irrigation with saline or other solutions Several studies have shown no reduction in wound infection rates when using sterile gloves during wound care Recent study in the Netherlands compared infection rates

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03:34

Podcast 840: Abnormal Pediatric Vitals at Discharge

Emergency Medical Minute ·

2022/12/29

Contributor: Aaron Lessen, MD Educational Pearls: Pediatric patients frequently have vital signs considered abnormal for age at discharge Large multicenter study recently evaluated if pediatric patients discharged with abnormal vital signs have worse outcomes 97,824 pediatric discharges were included in the study 18.1% were discharged with vitals considered abnormal for age No significant difference in readmission rates at 48 hours (2.28% in abnormal cohort vs. 2.45% in normal cohort) No

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03:21

Podcast 839: Causes of Pancreatitis

Emergency Medical Minute ·

2022/12/19

Contributor: Travis Barlock, MD Educational Pearls: The causes of pancreatitis can be remembered with the mnemonic: “GET SMASHED” G: Gallstones (Most common cause of pancreatitis overall) E: Ethanol (Alcohol consumption is the most common cause of chronic pancreatitis) T: Trauma S: Steroids M: Malignancy A: Autoimmune S: Scorpion Sting H: Hypertryglyceridemia E: ERCP D: Drugs (e.g. Valproate, Antiretrovirals) References Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic

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04:34

Podcast 838: Sternoclavicular Septic Arthritis

Emergency Medical Minute ·

2022/12/13

Contributor: Aaron Lessen, MD Educational Pearls: Septic arthritis of the sternoclavicular joint is uncommon accounting for <1% of septic arthritis cases Immunosuppression and IV drug use increases the risk Can account for up to 17% of septic arthritis cases in patients who use IV drugs Symptoms are typically vague with pain presenting around where the sternum meets the clavicle Consider imaging with CT or MRI and draining/analyzing the fluid if possible Antibiotics are the mainstay of

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06:07

Podcast 837: Snakebites

Emergency Medical Minute ·

2022/12/12

Contributor: Meghan Hurley, MD Educational Pearls: Venomous snakes in the United States include species from the family Elapidae and subfamily Crotalinae In prehospital setting, elevate the bitten extremity and transport to hospital immediately Do not attempt interventions with the bite site Monitor for progression of swelling past any joint line, systemic symptoms or lab abnormalities for 8-12 hours Symptoms may present up to hours after bite Crotalinae venom has heme toxicity and may

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03:28

Podcast 836: Humming to get EJ

Emergency Medical Minute ·

2022/12/06

Contributor: Jared Scott, MD Educational Pearls: Two conventional ways to aid in external jugular vein (EJ) catheter placement are Trendelenburg’s position and Valsalva’s maneuver by patient One study compared ultrasound visualization of cross sections of EJ and common femoral vein at baseline and with patients in Trendelenburg's position, Valsalva's maneuver, and while humming The study found all three conditions distended the veins from baseline, but there was no significant difference in

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06:22

Podcast 835: Syncope Review

Emergency Medical Minute ·

2022/12/05

Contributor: Meghan Hurley, MD Educational Pearls: Syncope is defined as a loss of consciousness with an immediate return to baseline Differential is broad Cardiogenic Structural (aortic stenosis, HOCUM, etc.) Electrical (long QT syndrome, Brugada, etc.) Neurogenic/neurovascular (brain bleed, etc.) Seizure Everything else Hypoglycemia, anemia, and bleeding into the abdominal cavity are some potential causes to rule out Vasovagal Diagnosis of exclusion Work Up EKG Good H&P Labs especially

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03:46

Podcast 834: Peds Buckle Fractures

Emergency Medical Minute ·

2022/11/29

Contributor: Aaron Lessen, MD Educational Pearls: Torus (Buckle) fractures are a commonly encountered pediatric fracture pattern Typically presents as wrist pain secondary to a child falling on outstretched hand One edge of the bone “buckles” or bends because children’s bones are softer and more pliable Management Older studies have shown that short term immobilization with a velcro splint and primary care follow up is sufficient Recent randomized trial compared immobilization with Velcro splint

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05:16

Podcast 833: NS vs LR

Emergency Medical Minute ·

2022/11/28

Contributor: Travis Barlock, MD Educational Pearls: Normal Saline (NS) contains 154 mEq of both Sodium (Na) and Chloride (Cl), and has a pH of 5.5 Normal Na and Cl in adult humans are about 140 mEq/L and 103 mEq/L. respectively Excess negative charge resulting from hyperchloremia is managed via bicarbonate excretion leading to loss of base Overall, administration of NS drives metabolic acidosis Lactated Ringers (LR) contains 130 mEq of Na and 109 mEq Cl, and has a pH of 6.5 LR components

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51:43

CA Bridge Program and Health Disparities in the...

Emergency Medical Minute ·

2022/11/23

Happy Thanksgiving EMM listeners, Mason here wanting to extend a special thank you to all of you for tuning in to our show. Today we are featuring a special episode on health disparities in the opioid epidemic and their intersection with the ER that we produced for the Iowa Healthcare Collaborative’s Compass Opioid Stewardship Program, a national initiative to provide comprehensive education on opioid stewardship and best practices. In an effort to promote diversity, equity, and inclusion in

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05:21

Podcast 832: STD Checks

Emergency Medical Minute ·

2022/11/22

Educational Pearls: Most common sexually transmitted disease (STD) in North America: Human Papillomavirus (HPV) From the emergency department patients should be connected to follow-up care and educated on vaccine series Most common non-viral STD in North America: Trichomonas Vaginalis While men may be asymptomatic, they can transmit the disease to women who may experience irritation leading to increased likelihood of PID and contraction of other STDs and HIV Trichomonas is diagnosed via wet

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03:19

Podcast 831: O2 Targets

Emergency Medical Minute ·

2022/11/21

Contributor: Aaron Lessen,MD Educational Pearls: Recent study looked at mechanically ventilated patients in ED and ICU to determine if O2 saturation level impacted patient outcomes 2541 patients randomized to one of three target O2 saturation levels Low: 90% (Range: 88-92%) Intermediate: 94% (Range: 92-96%) High: 98% (Range: 96-100%) Outcome indicators Primary: Number of days alive and ventilator free by day 28 of hospital admission Secondary: Mortality at 28 days No significant

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03:06

Podcast 830: Peripheral IV Flow Rates

Emergency Medical Minute ·

2022/11/15

Contributor: Travis Barlock, MD Educational Pearls: Gauge and length of catheter are determinants of flow rate Smaller gauges produce higher flow rate Longer catheters reduce flow rate Common IV gauges produce predictable rates of flow: 20 gauge = 60 cc/min 18 gauge = 105 cc/min 16 gauge = 220 cc/min Central lines typically have two 18 gauge and one 16 gauge lumen, both with long catheters, producing the following slower flow rates: 18 gauge = 26 cc /min 16 gauge = 55 cc/min Sheath

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04:04

Podcast 829: Monkeypox

Emergency Medical Minute ·

2022/11/14

Contributor: Aaron Lessen, MD Educational Pearls: Monkeypox transmission is still occurring in the United States Transmitted by contact to exposed lesion MSM are a high-risk group for monkeypox infection Symptoms include rash and flu like symptoms Monkeypox lesions are often described as blister-like, firm, clear, and rubbery Most commonly develop on the face and/or anogenital regions Patients with potential monkeypox infection should be moved to isolation to reduce risk of transmission

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04:12

Podcast 828: TXA Dosing Update

Emergency Medical Minute ·

2022/11/08

Contributor: Nick Hatch, MD Educational Pearls: In the setting of traumatic injury, tranexamic acid (TXA) is given to stabilize clots which minimizes bleeding and decreases risk of hemorrhagic shock Current TXA dose for trauma is 1 g bolus followed by a 1 g infusion; both doses should be given within 3 hours from time of injury Due to the split dose and narrow window, patients with complicated care, particularly if they require transfer may miss the infusion dose Various smaller studies have

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02:50

Podcast 827: Allergies in Peds

Emergency Medical Minute ·

2022/11/07

Contributor: Aaron Lessen, MD Educational Pearls: Recent study evaluated if early exposure to an allergen impacted the rate of allergy development later in childhood Children were exposed to peanut, milk, wheat, and egg allergens at 3 months of age and then followed for 3 years 2.5-3% of children who were not exposed developed allergies to these allergens 1% of children exposed to the allergens developed allergies to these allerrgens Exposing 63 children to allergens at 3 months would prevent the

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04:00

Podcast 826: STEMI Equivalents

Emergency Medical Minute ·

2022/11/01

Contributor: Travis Barlock, MD Educational Pearls: The presence of a STEMI has traditionally been used to determine if a patient with acute chest pain requires urgent cath lab management STEMI indicates an occluded coronary artery, and urgent intervention is needed to restore perfusion to ischemic tissue Patients with occluded coronary arteries can present with EKG findings other than STEMI 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the

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