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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

02:59

Podcast 825: ALS vs PD Transport

Emergency Medical Minute ·

2022/10/31

Contributor: Aaron Lessen, MD Educational Pearls: In urban settings, it is becoming more common for police to transport critical patients from scene to hospital A 2022 multicenter observational study compared mortality rates in patients with penetrating injury to torso and/or proximal extremity when transported by EMS versus police Approximately 18% of patients were transported by police Overall mortality was approximately 15% in both groups In patients with more severe injury, mortality was

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03:00

Podcast 824: Catheter-Related Blood Infections

Emergency Medical Minute ·

2022/10/25

Contributor: Travis Barlock, MD Educational Pearls: Catheter related blood infections were thought to be caused by skin flora seeding the catheter. Thus, significant effort is applied to sterility and skin preparation. However, studies have shown that bacteria growing on the tip of the catheter is not consistent with growth on cultures of skin. Staphylococcus epidermidis is commonly found on cultures of catheter sites. It has also been found in the gut flora of >50% of ICU patients. Rates of

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07:18

Podcast 823: Immediate Resuscitative Thoracotomy

Emergency Medical Minute ·

2022/10/24

Contributor: Jared Scott, MD Educational Pearls: Immediate resuscitative thoracotomy can be performed in the ED to gain rapid access to the thoracic cavity in cases of traumatic cardiac arrest Western Trauma Association Society Criteria for ED thoracotomy Blunt trauma + <10 min of prehospital CPR Penetrating trauma to torso + <15 min prehospital CPR Penetrating trauma to the neck/extremity + <5 min prehospital CPR Signs of life with refractory shock can consider resuscitative thoracotomy

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03:16

Podcast 822: Meralgia Paresthetica

Emergency Medical Minute ·

2022/10/18

Contributor: Aaron Lessen, MD Educational Pearls: Lateral Cutaneous Femoral Nerve Entrapment Syndrome, also known as Meralgia Paresthetica, results from entrapment of the lateral cutaneous femoral nerve, often as it exits the pelvis under the inguinal ligament. Meralgia Paresthetica is associated with obesity, pregnancy, compression from clothing or belts and diabetes. Symptoms include numbness, paresthesia and pain of the proximal lateral thigh. Signs or symptoms of radiculopathy such as

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04:30

Podcast 821: EKGs in Syncope

Emergency Medical Minute ·

2022/10/17

Contributor: Travis Barlock, MD Educational Pearls: An EKG should be obtained quickly after a syncopal event to identify possible life-threatening causes such as ischemia and arrhythmia WOBBLER is a good mnemonic for remembering additional EKG findings to look for in syncope Wolff-Parkinson-White (WPW) Check for delta wave on QRS Obstructed AV node Any potential heart blocks Brugada syndrome Na channel blockade that can cause ST elevations in anterior leads Bifascicular block

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04:00

Podcast 820: Who Qualifies for Take-Home Naloxone

Emergency Medical Minute ·

2022/10/11

Contributor: Don Stader, MD Educational Pearls: Home naloxone is traditionally given to those at high risk for opioid overdose such as those in the ED due to an opioid overdose, opioid intoxication, or admit to illicit opioid use There are a number of other patient populations that benefit from home naloxone including those on chronic opioid or benzodiazepine therapy, and those who report any type of illicit drug use Any illicit drug could be laced with opioids, and those who use drugs are

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05:00

Podcast 819: Indiscriminate Lactate Testing

Emergency Medical Minute ·

2022/10/10

Contributor: Jared Scott, MD Educational Pearls: Elevated lactate levels can be a useful indicator of critical illness in patients who meet SIRS criteria Lactate can also be elevated due to other causes including seizures and medications such as albuterol and metformin A recent study from Switzerland* performed routine point-of-care lactate testing in all elderly patients presenting at triage in the emergency department in order to determine the prevalence of elevated lactate in the

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06:50

Podcast 818: Local Anesthetics and LAST

Emergency Medical Minute ·

2022/10/04

Contributor: Don Stader, MD Educational Pearls: There are two major groups of local anesthetics: Amide and Esther To recall what group an anesthetic belongs to, use this memory trick: Amide has an ‘i’ in the name and Amide anesthetics have 2 ‘i’s e.g., Lidocaine. Ester has no ‘i’ and most common Ester anesthetics have only one ‘i’ e.g., Tetracaine. In a true allergy and/or contraindication to both local anesthetic groups, diphenhydramine is an acceptable alternative. Epinephrine is

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02:23

Podcast 817: MI Risk during Elections

Emergency Medical Minute ·

2022/10/03

Contributor: Aaron Lessen, MD Educational Pearls: 2020 retrospective study with dat from two California hospitals compared rates of cardiovascular admissions in a five day period two weeks before and the five days after the presidential election Hospitalization rate for acute cardiovascular disease increased by 17% and rate of acute myocardial infarction increased by 42% Highest rates occurred in demographic of white males older than 75 years old No significant difference between groups

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04:15

Podcast 816: Ventilator Management in Asthmatics

Emergency Medical Minute ·

2022/09/27

Contributor: Aaron Lessen, MD Educational Pearls: The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation Asthma is an obstructive airway disease that can cause air trapping and hyperinflation of the lungs To avoid worsening hyperinflation patients typically require slower respiratory rates, lower tidal volumes, and increased expiratory time when on a ventilator Patients on a ventilator require very close monitoring to prevent

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03:21

Podcast 815: Fluid Resuscitation in Pancreatitis

Emergency Medical Minute ·

2022/09/26

Contributor: Aaron Lessen, MD Educational Pearls: Historically, pancreatitis has been treated with aggressive IV fluid rehydration. Recently published data shows this may not be appropriate. A randomized, controlled, multi-hospital trial evaluated outcomes for patients with acute pancreatitis receiving lactated Ringer’s solution Aggressive fluid resuscitation group received 20ml/kg bolus + 3ml/hour Moderate fluid resuscitation groups received either 10 ml/kg bolus if hypovolemic or no bolus if

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02:50

Podcast 814: Post-concussion Treatment

Emergency Medical Minute ·

2022/09/19

Contributor: Aaron Lessen, MD Educational Pearls: Recent study looked at the impact of screen time on duration of post-concussive symptoms 125 patients aged 12-25 diagnosed with a concussion were randomized to either abstain from or have unrestricted screen time for 48 hours after injury Patients with unrestricted screen time averaged approximately 5 hours/day of screen time Patients in the no screen time group averaged approximately 1 hour/day of screen time Statistically significant difference in

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04:13

Podcast 813: Pulse Oximetry

Emergency Medical Minute ·

2022/09/13

Contributor: Travis Barlock, MD Educational Pearls: Most oxygen in the body is bound to hemoglobin, forming oxyhemoglobin. Less than 1% of the oxygen in the body is dissolved in plasma. Pulse Oximeters (Pulse Ox) function by emitting wavelengths of light from one side, and capturing the amount absorbed on the opposite side. A calculation determined the amount of saturation. Pulse Ox relies on pulsations in arterial flow to create a photoplethysmogram (pleth) for measurements Patients with poor

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03:26

Podcast 812: PO Medications

Emergency Medical Minute ·

2022/09/12

Contributor: Nick Tsipis, MD Educational Pearls: PO medications are less frequently used in the ED due to their longer onset of action The position the patient is in when given PO medications may affect how quickly the medication is absorbed The quicker the medication passes through the stomach into the small intestine, the quicker it can be absorbed and metabolized Recent study used in silico gastric biomechanics model to compare the length of time it took PO medications to pass through

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03:13

Podcast 811: Ketamine for Pain

Emergency Medical Minute ·

2022/09/07

Contributor: Lessen, Aaron MD Educational Pearls: Ketamine can be given at 0.2-0.3 mg/kg as subdissociative doses for pain control in the ED Ketamine coadministered with Haldol may reduce agitation A recent study in Iran compared subdissociative Ketamine given with 2.5 mg Haldol to 1 mg/kg Fentanyl for pain control in the ED Ketamine with Haldol had better pain control than Fentanyl at 5, 10, 15 and 30 minutes Ketamine with Haldol less frequently required rescue medication Ketamine with

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04:32

Podcast 810: Tooth Replantation

Emergency Medical Minute ·

2022/09/05

Contributor: Jarod Scott, MD Educational Pearls: There is a 1-hour window for tooth replantation in ED Cold milk is often best transport media unless there is access to specialized solutions (Hank’s Balanced Solution) Goal is to preserve periodontal ligament Soaking in tap water should be avoided as it will lyse cells of periodontal ligament If oral surgeon is rapidly available, have them perform replantation Do not delay replantation to wait for an oral surgeon to become available Steps in

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04:31

Podcast 809: Achilles Tendon Rupture

Emergency Medical Minute ·

2022/08/30

Contributor: Aaron Lessen, MD Educational Pearls: Achilles tendon rupture usually presents in younger, healthy patients after a sports injury Patients typically present complaining of an abrupt onset ankle pain after feeling a “pop” Pain can be localized to posterior ankle and patient’s lack the ability to plantarflex Achilles rupture is a clinical diagnosis and does not usually require imaging in the ED Thompson test Having patient lay on their stomach and squeezing the calf on the injured

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04:55

Podcast 808: BVM and PEEP Valve

Emergency Medical Minute ·

2022/08/29

Contributor: Dylan Luyten, MD Educational Pearls: Positive End Expiratory Pressure (PEEP) is positive pressure within the lungs and maintained throughout the entire respiratory cycle. It is the pressure preventing alveoli from collapsing at the end of exhalation. When using a bag valve mask (BVM) to ventilate patients, always attach the PEEP valve to prevent intrathoracic pressure from returning to atmospheric pressure which would allow alveoli collapse. A BVM with a good seal to patients face

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04:11

Podcast 807: Ring Removal Tricks

Emergency Medical Minute ·

2022/08/23

Contributor: Jared Scott, MD Educational Pearls: If a patient is in significant pain, a digital block can be helpful. Pain management alone may allow for manual ring removal. Ring cutters and trauma shears with specialized ring cutters can be attempted but will destroy the ring and some materials may be resistant to cutting. 2 alternative options are presented which aim to reduce edema above the ring to assist removal: Move the ring as proximally as possible. Wrap large size suture from the

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03:53

Podcast 806: Normal ECGs

Emergency Medical Minute ·

2022/08/22

Contributor: Jared Scott, MD Educational Pearls: Physicians are typically advised not to trust computer interpretation of ECGs Retrospective study was done of computer interpreted normal ECGs to evaluate the accuracy of such an interpretation 989 ECGs were interpreted as “Normal sinus rhythm, Normal ECG” by proprietary cardiology software on MUSE Cardiology Information System These EKGs received follow up interpretation by cardiologists which was considered the “gold standard” for interpretation

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