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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

03:35

Podcast 771: Intubation in Cardiac Arrest

Emergency Medical Minute ·

2022/04/11

Contributor: Don Stader, MD Educational Pearls: In a secondary analysis of the PART trial, the mortality effect of timing of airway management for patients in cardiac arrest was examined Study looked at whether timing played a part in both laryngeal tube placement or endotracheal intubation during cardiac arrest Did not find any association of timing and survival to hospital discharge High-quality CPR and defibrillation are the only two things that improve outcomes in cardiac arrest References

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03:45

Podcast 770: Xylazine

Emergency Medical Minute ·

2022/04/05

Contributor: Don Stader, MD Educational Pearls: Xylazine, referred to as tranq dope colloquially, is an FDA approved animal tranquilizer that is circulating in the illicit drug markets of the northeastern United states It is a powerful alpha-2 agonist, similar to clonidine, and patients with xylazine overdose may present similarly to opioid overdose Naloxone will not reverse the effects of xylazine and management is supportive care Withdrawal symptoms from xylazine use can be treated with clonidine

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03:01

Podcast 769: Pressors After Cardiac Arrest

Emergency Medical Minute ·

2022/04/04

Contributor: Aaron Lessen, MD Educational Pearls: Hypotension after cardiac arrest often requires a vasopressor to improve blood pressure Recent observational study from France examined outcomes of patients who received either epinephrine or norepinephrine for post-resuscitation shock Norepinephrine had significantly better outcomes Death from shock was 35% in the epinephrine group vs. 9% in the norepinephrine group Recurrent cardiac arrest was 9% in epinephrine group vs. 3% in norepinephrine

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16:43

Mental Health Monthly #11: De-escalation: Changing...

Emergency Medical Minute ·

2022/03/30

Contributor: Dr. Kimberly Nordstrom De-escalation usually takes less time than physical and chemical restraints, which leads to decreased injury to staff members, better patient trust and increased patient throughput as accepting facilities oftentimes delay transfer acceptance following physical restraints Prepare to engage prior to entering their room in two ways: cognitively and emotionally Why do you want to de-escalate the patient? Remind yourself you don’t want to introduce more trauma Check

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04:42

Podcast 768: Takotsubo Cardiomyopathy

Emergency Medical Minute ·

2022/03/29

Contributor: Peter Bakes, MD Educational Pearls: 3% of cases of acute coronary syndrome are due to Takotsubo Takotsubo cardiomyopathy or “broken heart syndrome” can occur with severe physiologic or emotional stressors, as these events can result in a profound outpouring of sympathetic neurotransmitters (epinephrine/norepinephrine) Receptors for these catecholamines are very dense around the apex of the heart, so the apical aspect of the heart can balloon outward as a result of this surge Most

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03:01

Podcast 767: Transaminitis and Rhabdomyolysis

Emergency Medical Minute ·

2022/03/28

Contributor: Sam Killian, MD Educational Pearls: Transaminitis refers to the elevation of transaminases, enzymes of the liver (AST and ALT) Elevation of ALT is relatively specific to the liver, but AST is found in more organs than the liver including the muscle If AST is significantly greater than ALT, consider a musculoskeletal origin such as rhabdomyolysis Transaminitis is not always a liver specific issue References Lala V, Goyal A, Minter DA. Liver Function Tests. [Updated 2021 Aug 20]. In:

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03:55

Podcast 766: Truth about Tramadol

Emergency Medical Minute ·

2022/03/22

Contributor: Aaron Lessen, MD Educational Pearls: Tramadol is often thought of as a mild-opiate to use for analgesia, but it is a more complicated drug Tramadol needs to be metabolized into an effective drug making it not pharmacologically reliable 3-10% of people cannot metabolize tramadol and it does not work Some others over-metabolize tramadol and it causes greater effect Studies have shown it is not any better as a acetaminophen or ibuprofen for analgesia, it can lower a seizure threshold,

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02:25

Podcast 765: Phenobarbital for Alcohol Withdrawal

Emergency Medical Minute ·

2022/03/21

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study looked at return rate of discharged patients after receiving either phenobarbital or benzodiazepines or both in the ED for treatment of alcohol withdrawal Patients who received benzodiazepines had a 25% chance of returning in 3 days versus a 10% chance of returning in 3 days for those who received phenobarbital 13% of patients returned in 3 days after receiving both phenobarbital and benzodiazepines Phenobarbital may make

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03:24

Podcast 764: Myth or Merit: Beta-Blockers for Cocaine...

Emergency Medical Minute ·

2022/03/15

Contributor: Chris Holmes, MD Educational Pearls: Many are taught that patients with cocaine chest pain should not receive beta-blockers due to unopposed alpha agonism, but is this true? 363 consecutive admissions for chest pain with positive cocaine on urine toxicology were reviewed in a retrospective cohort study 60 patients in this cohort received a beta-blocker and multivariate analysis demonstrated a reduction in myocardial infarction risk Another retrospective cohort study demonstrated no

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03:16

Podcast 763: Sternoclavicular Infection

Emergency Medical Minute ·

2022/03/14

Contributor: Aaron Lessen, MD Educational Pearls: Septic arthritis can occur at any joint, including the sternoclavicular joint Sternoclavicular joint infections comprise 1% of all bone and joint infections Patients who use intravenous drugs have a higher occurrence of this type of infection compared to the general population, accounting for 17% of all sternoclavicular joint infections Usual treatment includes intravenous antibiotics and, in some cases, surgery References Tapscott DC, Benham MD

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50:30

UnfilterED #14: Patricia Hernandez, MSIV and Leyanet...

Emergency Medical Minute ·

2022/03/09

Tune in for a double feature with our Equity, Diversity and Inclusion Award winners from this fall as Nick asks them about their backgrounds, what brought them into medicine and Emergency Medicine specifically. Patricia is a 4th year medical student at PennMed. As a first-generation immigrant, college, and medical student, she is committed to actively promoting and being an advocate for diversity, equity, and inclusion because she sees the value in having a diverse workforce to build a more

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05:26

Podcast 762: Endocarditis

Emergency Medical Minute ·

2022/03/08

Contributor: Jared Scott, MD Educational Pearls: Variability of organisms in infecting the myocardial valves Duke Criteria for Infective Endocarditis includes three categories that can be used to definitively diagnose endocarditis Pathologic Criteria pathological evidence of infection Major Clinical Criteria positive blood cultures positive echocardiogram findings (TEE is more sensitive than a TTE) Minor Clinical Criteria (must include all of the below criteria) Fever Underlying heart

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06:35

Podcast 761: Peritonsillar Abscess: To Stab or Not to...

Emergency Medical Minute ·

2022/03/07

Contributor: Jared Scott, MD Educational Pearls: Often present with complaints of sore throat, pain with swallowing, difficulty swallowing, voice change, and possible fever Retrospective study from 2018 evaluated outcomes of peritonsillar abscess with two management arms, surgical vs. non-surgical treatment Non-surgical treatment only included IV fluids as well as IV ceftriaxone + clindamycin; Surgical treatment included either needle aspiration or incision and drainage of the abscess as well as

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08:00

Podcast 760: Why Fentanyl is the Worst

Emergency Medical Minute ·

2022/03/01

Contributor: Don Stader, MD Educational Pearls: Fentanyl’s common administration route through pills has lowered the psychological barrier of using opioid compared to injecting and smoking heroin Fentanyl is showing up in all illicit drugs with documented cases even in marijuana Testing for fentanyl is difficult and requires a send out test because UA does not show up not common in ED but can better inform our care Fentanyl doesn’t show up on UA drug screen and requires a send out test, thus we

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05:13

Podcast 759: Hyperkalemia and Myth of Kayexalate

Emergency Medical Minute ·

2022/02/28

Contributor: Nick Tsipis, MD Educational Pearls: Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples Hyperkalemia is commonly associated with end stage renal disease, acute kidney injury or acute renal failure Cardiac dysrhythmias are the primary concern with hyperkalemia, common EKG changes (and approximate serum levels) can include: Peaked T waves that start to show at serum K of 6 Second sign is lengthening of PR and QRS intervals due to extended

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11:07

Mental Health Monthly #10: The Elderly Psychotic Patient

Emergency Medical Minute ·

2022/02/23

Dr. Kim Nordstrom, a practicing emergency psychiatrist and associate professor with the University of Colorado, discusses various work-up models alongside valuable bedside tools for elderly patients with acute psychosis. In this podcast, she explores the methods to differentiate primary psychiatric psychosis from medically mediated psychosis in the elderly using an empirical bedside tool. Furthermore, Dr. Nordstrom educates our listeners on the treatment modalities available and currently

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03:04

Podcast 758: Vaccine Safety During Pregnancy

Emergency Medical Minute ·

2022/02/22

Contributor: Nick Tsipis, MD Educational Pearls: Observational study in Israel evaluated cohort of vaccinated pregnant women receiving the initial Pfizer-BioNTech COVID-19 mRNA vaccine Looked at 24,288 newborns with about 16,697 exposed to maternal vaccination in utero Longitudinal follow up showed no significant difference in preterm births, neonatal hospitalizations, post-natal hospitalizations, congenital abnormalities, or mortality While this is not a randomized-controlled trial, this

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06:18

Podcast 757: History of Fevers and Thermometers

Emergency Medical Minute ·

2022/02/21

Contributor: Chris Holmes, MD Educational Pearls: Dr. Carl Reinhold August Wunderlich, of the mid-1800s, was the first physician to suggest temperature was related to disease processes and his measurements set the 37˚C (98.6˚F) as the baseline temperature Thermometers were adapted to be sold to the public with guidelines for temperature measurement interpretation Taller and thinner individuals, anyone taking a temperature in the morning, and the elderly have decreased temperatures Temperature

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04:58

Podcast 756: Violence Towards ED Staff

Emergency Medical Minute ·

2022/02/15

Contributor: Jared Scott, MD Educational Pearls: ACEP survey was done in 2018 looking at violence towards staff in the ED with only 10% of those solicited responding Survey found 47% of respondents were assaulted and 71% had witnessed violence towards staff Regarding what was done about the violence, 28% said patients were flagged by the hospital, 21% said patient was arrested by police/hospital security, 6% of the cases resulted in the hospital pressing charges, and in 3% of cases the staff were

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03:49

Podcast 755: Tubo-Ovarian Abscess

Emergency Medical Minute ·

2022/02/14

Contributor: Peter Bakes, MD Educational Pearls: Tubo-ovarian abscess is a rare complication of pelvic inflammatory disease Usually presents with chief complaint of abdominal pain and is often diagnosed by CT of the abdomen/pelvis Hospitalization is indicated 60-80% of patients improve with an IV anaerobic cephalosporin (cefoxitin or cefotetan) with doxycycline or using clindamycin and gentamicin Mortality can occur in up to 5% of patients, often as a result of progression to septic shock

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