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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

03:15

Podcast 805: Tunneled Peritoneal Catheter

Emergency Medical Minute ·

2022/08/16

Contributor: Aaron Lessen, MD Educational Pearls: Patients with recurrent ascites may need frequent outpatient or emergency department paracentesis which can be time consuming and uncomfortable for patients. Tunneled peritoneal catheters are a permanent alternative therapy which allows fluid drainage at home by patient or caregiver. There has been theoretical concern that long term placement of tunneled peritoneal catheters may increase risk of infection, thus they are more commonly placed as a

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06:21

Podcast 804: Brugada Criteria for V Tach

Emergency Medical Minute ·

2022/08/09

Contributor: Peter Bakes, MD Educational Pearls: Tachycardia describes a heart rate of >120 beats per minute Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG The major differential for a wide complex tachycardia is Ventricular Tachycardia (VT), aka “V Tach”, or Supraventricular Tachycardia (SVT) with Aberrancy SVT alone is a narrow complex tachycardia, but as rate increases a right or left bundle branch block pattern may emerge, creating SVT with Aberrancy seen

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03:07

Podcast 803: Sedation During Intubation

Emergency Medical Minute ·

2022/08/08

Contributor: Aaron Lessen, MD Educational Pearls: Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications Patients who suffer from this effect are at high risk of developing severe PTSD, depression, and suicidal ideations Occurs in approximately 0.1-0.2% of patients undergoing general anesthesia in an OR setting 2021 study showed patients intubated in the ED have a much higher rate of experiencing awareness during intubation 2.6% chance

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01:06:06

Pediatric Palliative Care Expert Panel

Emergency Medical Minute ·

2022/08/03

Selected audio from our event, Palliative, hosted on June 27, 2022 in conjunction with Children's Hospital Colorado's Department of Palliative Medicine and The Denver Hospice's Footprints Program. Keynote address by Dr. Nadia Tremonti, pediatric palliative care physician at Children's Hospital of Michigan Expert Panel composed of Dr. Kimberly Bennett, medical director for TDH's Footprints Program, Dora Mueller, clinical nurse coordinator for palliative care at Children's and Cassie Matz, LCSW

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03:24

Podcast 802: Intranasal Medication Administration for...

Emergency Medical Minute ·

2022/08/02

Contributor: Aaron Lessen, MD Educational Pearls: Intranasal medication administration is a convenient, quick, and relatively painless option for pediatric patients Often used as an initial medication to help control pain in children prior to establishing an IV Using an atomizer is preferred when administering intranasal medications The syringe should be angled towards the ipsilateral eye or occiput rather than straight upwards Do not administer more than 1 mL of fluid per nostril as volumes

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24:05

Mental Health Monthly #14: Substance-Induced...

Emergency Medical Minute ·

2022/07/27

In this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from

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03:10

Podcast 801: Push Dose Vasopressors

Emergency Medical Minute ·

2022/07/26

Contributor: Aaron Lessen, MD Educational Pearls: There are two common options for push-dose vasopressor: phenylephrine and epinephrine. Both have been studied in the setting of the OR, but are lacking data in emergency room utilization. A recent retrospective study at one hospital compared the two options for effectiveness and safety. The data showed phenylephrine raised systolic pressure an average 26 points while epinephrine raised the systolic pressure higher, an average of 33 points

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02:30

Podcast 800: Mortality in Fevers

Emergency Medical Minute ·

2022/07/25

Contributor: Aaron Lessen, MD Educational Pearls: A recent study evaluated the association between the degree of fever and mortality rate in patients presenting to a set of Emergency Departments in Israel Febrile patients with a temperature > 38.0 C were recorded and these patients were compared against local death records to determine the all-cause 30-day mortality rate 8.1% of patients evaluated in the ED were determined to be febrile 30-day mortality for all febrile patients was around 12%

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04:00

Podcast 799: EKG Abnormalities in Renal Failure

Emergency Medical Minute ·

2022/07/19

Contributor: Peter Bakes, MD Educational Pearls: Patients in renal failure may have elevated serum potassium levels which can result in EKG changes. EKG changes in the setting of hyperkalemia generally depend on the serum level. Mild elevation may cause peaked T waves. At higher serum levels there will be loss of P waves plus wide complex tachycardia. There can be progression to fatal arrhythmias. Treatment of acute hyperkalemia involves multiple mechanisms. Calcium gluconate stabilizes the

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Podcast 798: Digit Reimplantation

Emergency Medical Minute ·

2022/07/18

Contributor: Aaron Lessen, MD Educational Pearls: Multiple factors affect if a digit can be reattached including: location of digit injury, mechanism of injury, duration since injury, preservation mechanism. Recommended preservation is via indirect cooling. This is accomplished by wrapping the amputated digit piece in saline soaked gauze, placing the wrapped piece in a waterproof bag and putting the bag in ice water for transport. Avoid direct contact of the digit with ice. A single center study

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02:43

Podcast 797: Vitamin C in Sepsis

Emergency Medical Minute ·

2022/07/12

Contributor: Aaron Lessen, MD Educational Pearls: Prior, smaller studies showed intravenous Vitamin C given to patients with sepsis significantly improved patient mortality and additional outcomes. A recently published, randomized control trial with >800 ICU patients who received up to 4 days of IV Vit C or placebo concluded that the end points of death or persistent organ dysfunction at 28 days were unaffected by Vitamin C administration. There were no adverse safety outcomes associated with

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03:05

Podcast 796: Fluid Amounts in Septic Shock

Emergency Medical Minute ·

2022/07/11

Contributor: Aaron Lessen, MD Educational Pearls: Septic shock management has traditionally endorsed rapid fluid resuscitation and the administration of vasopressors Current guidelines are for patients to initially receive a 30 ml/kg fluid bolus then additional fluid as needed for continued hypotension The ideal volume of fluid needed to maximize patient outcomes has been debated A recent ICU-based study examined mortality differences between patient receiving restricted vs standard fluid therapy

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04:44

Podcast 795: Lithium Toxicity

Emergency Medical Minute ·

2022/07/05

Contributor: Peter Bakes, MD Educational Pearls: Lithium remains a commonly used medication for treating bipolar disorder Lithium toxicity can be acute, acute-on-chronic, or chronic Measuring blood lithium level Therapeutic range of lithium is around 1.6-1.8 mEq/L >2 mEq/L is likely to cause significant toxicity >4 mEq/L necessitates lifesaving treatment The lethal dose of lithium is 700 mg/kg Lithium can have delayed absorption resulting in levels increasing during hospitalization Symptoms

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Podcast 794: Brain and Pain

Emergency Medical Minute ·

2022/07/04

Contributor: Don Stader, MD Educational Pearls: Pain sensation is generated and modified by the brain Multiple case reports provide evidence that the degree of pain a patient experiences correlates with how severe they perceive their injury/illness to be Patients who feel safe and reassured about the care they are receiving have less pain The patient’s narrative about their pain is the strongest factor in determining long-term outcomes of their pain Helping to shape the narrative around

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06:17

Podcast 793: Postintubation Sedation and Analgesia

Emergency Medical Minute ·

2022/06/27

Contributor: Peter Bakes, MD Educational Pearls: When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for patients with intracranial bleeds Precedex is a milder sedative used in the ICU because it decreases time to

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04:45

Podcast 792: Rectal Prolapse

Emergency Medical Minute ·

2022/06/21

Contributor: Jarod Scott, MD Educational Pearls: Rectal prolapse is an evagination of the rectal tissue through the anal opening Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities Noninvasive treatment options include increasing fluid and fiber intake to soften stools as well as using padding/taping to

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03:44

Podcast 791: Hyperglycemic Hyperosmolar State

Emergency Medical Minute ·

2022/06/20

Contributor: Aaron Lessen, MD Educational Pearls: Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality Unlike in DKA, patients with HHS do not have elevated ketones Treatment of HHS includes insulin administration along with correcting fluid and

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18:03

On the Streets #14: Trauma Activations in the Field

Emergency Medical Minute ·

2022/06/15

The Emergency Medical Minute is excited to announce that we our upcoming event, Palliative. Check out our event page for more information and to buy tickets: Palliative Eventbrite Page

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03:04

Podcast 790: Opioids vs OTC Pain Meds

Emergency Medical Minute ·

2022/06/14

Contributor: Aaron Lessen, MD Educational Pearls: NSAIDs are a potential alternative to opioids for pain management and are associated with decreased rates of adverse effects A recent study evaluated the effectiveness of ibuprofen and oxycodone for pain management in pediatric patients with isolated, acute-limb fractures Participants were discharged home with either ibuprofen or oxycodone and followed for six weeks There was no difference in pain scores between those taking ibuprofen and those

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03:07

Podcast 789: DOAC

Emergency Medical Minute ·

2022/06/13

Contributor: Aaron Lessen, MD Educational Pearls: Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis. Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes. 2 large observational studies evaluated the recurrence of clots and bleeding risk in patients

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