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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

03:19

Podcast 717: A cautionary tale of renal failure

Emergency Medical Minute ·

2021/10/04

Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia can cause EKG changes such as a widened QRS The fastest electrolyte results can be obtained off a VBG with electrolytes or point-of-care labs Hyperkalemia may be reported as “hemolyzed” which indicated lysis of red blood cells and artificial elevation of the potassium level. However, always keep in mind the clinical context and look at other metabolic abnormalities like creatinine and BUN for other clues that it may actually not be

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04:34

Podcast 716: Resuscitation Fluids

Emergency Medical Minute ·

2021/09/29

Contributor: Nick Tsipis, MD Educational Pearls: Fluid choice may have an impact on outcomes in resuscitation, and a meta-analysis has relevant insight into their use in sepsis and trauma patients Large volume normal saline fluid resuscitation in sepsis is associated with acute kidney injury and metabolic acidosis compared to Lactated Ringers Choice of fluid did not have significant differences in trauma patients for initial resuscitation References Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu

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04:59

Podcast 715: Heated High Flow O2

Emergency Medical Minute ·

2021/09/27

Contributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or “heated high flow” can deliver higher oxygen levels than nasal cannula It typically is used as an “intermediate” between oxygen via nasal cannula and other non-invasive positive pressure devices, such as BiPAP Can modify both the FiO2 and flow rate Maximum flow rate is typically 60 liters per minute (compare that to a typical breath that is 30-40 L/min) Humidification of HFNC is important due to risk of epistaxis

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03:26

Podcast 714: Intradermal Sterile Water for Back Pain

Emergency Medical Minute ·

2021/09/21

Contributor: Aaron Lessen, MD Educational Pearls: Randomized controlled-trial evaluated intradermal injections of sterile water to manage low back pain versus an IV NSAID Four intradermal injections of 0.1 cc sterile water in a square around the area of musculoskeletal pain Reduction of pain was 7 points with the procedure and 2 points with the IV NSAID at 24 hours 12% in the injection group versus 50% in the IV NSAID group needed opioids 87% patient satisfaction in the injection group versus 16%

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03:48

Podcast 713: Oral Ketamine

Emergency Medical Minute ·

2021/09/20

Contributor: Don Stader, MD Educational Pearls: Those on chronic opioid therapy may have high tolerance to opioids and/or opioid hyperalgesia Ketamine is a good adjunct for pain control in patients on chronic opioid therapy To avoid the time constraints often required to push ketamine intravenously, it can be given orally: Ketamine IV 25-50 mg (~0.01-0.03 mg/kg) as a single dose by mouth References Blonk M, Koder B, et al. Use of oral ketamine in chronic pain management: A review. European

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03:20

Podcast 712: Cephalosporin with a Penicillin Allergy

Emergency Medical Minute ·

2021/09/13

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study in the Kaiser system looked at over 4 million patients receiving antibiotics to determine the effect of penicillin allergy prompts in the EHR on antibiotic prescribing Half of the sites removed prompts stating penicillin allergy and half kept the prompts Patients with penicillin allergies who received cephalosporins went up from 20% to 27% in areas where the prompt was remove No difference in mortality or no new allergies

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15:57

On the Streets #10: IO Administration Gone Awry

Emergency Medical Minute ·

2021/09/08

Dr. Glenda Quan, trauma surgeon from Swedish Medical Center joins our host Jordan Ourada to review a case of an incorrectly placed IO and how to avoid it. The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.

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04:35

Podcast 711: Insulin Pumps

Emergency Medical Minute ·

2021/09/07

Contributor: Aaron Lessen, MD Educational Pearls: Insulin pumps provide a continuous infusion of fast-acting insulin using a basal rate and bolus prior to meals Some connect to a continuous glucometer but often blood glucose needs to be checked manually Hypoglycemia is rarely due to a malfunctioning pump - there is usually an another external factor Hyperglycemia can be caused by underdosing, illness, pump malfunction or expired insulin The pump can be used to give a bolus of insulin in the

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05:24

Podcast 710: Droperidol vs. Zyprexa

Emergency Medical Minute ·

2021/08/31

Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about 16 minutes for both agents Droperidol was slightly less sedating than olanzapine and length of stay for olanzapine was longer Olanzapine had a higher rate of requiring another agent for adequate sedation Droperidol had a higher rate of adverse events (mainly extrapyramidal symptoms) than olanzapine

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04:52

Podcast 709: Clown Therapy

Emergency Medical Minute ·

2021/08/30

Contributor: Jared Scott, MD Educational Pearls: Using LET, procedural sedation, and distraction techniques are often needed to successfully perform painful procedures in pediatrics patients The technique of clown therapy has been studied as an adjunct to LET and other distraction techniques for procedures in pediatric patients One randomized-controlled trial from 2016 found anxiety was greatly reduced using medical clown therapy to aid in painful procedures in pediatrics patients References

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05:15

Podcast 708: Diagnostic Paracentesis

Emergency Medical Minute ·

2021/08/24

Contributor: Peter Bakes, MD Educational Pearls: Paracentesis is a procedure where fluid is removed from the peritoneal cavity by needle Indications for paracentesis include: large volume paracentesis (5-6L), diagnosis of transudative or exudative ascites, evaluation for spontaneous bacterial peritonitis (SBP) Infection of ascitic fluid is more likely in transudative processes due to the increased frequency of paracentesis E coli is the most common pathogen to cause SBP Treatment with 3rd

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03:00

Podcast 707: Sigmoid Volvulus

Emergency Medical Minute ·

2021/08/23

Contributor: Aaron Lessen, MD Educational Pearls: Sigmoid volvulus occurs when the sigmoid colon twists 180 to 360 degrees 10% of intestinal obstructions in the US; 50-70% of intestinal obstructions worldwide More common in elderly patients with chronic constipation Eventually may lead to bowel perforation, a surgical emergency Treatment is sigmoidoscopy or sigmoid colectomy References Lieske B, Antunes C. Sigmoid Volvulus. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL):

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03:09

Podcast 706: Pepper Spray Decon

Emergency Medical Minute ·

2021/08/18

Contributor: Ramnik Dhaliwal, MD JD Educational Pearls: Pepper spray is a highly irritating compound with active ingredient of capsaicin Techniques to help decontaminate and alleviate symptoms of an exposure include: Disrobing the patient to prevent further exposure Half milk of magnesia and half water mixture can be used to soothe the skin in the area of exposure Proparacaine followed by Morgan lens to irrigate the eye in adults Nasal cannula connected to a liter of normal saline can passively

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04:02

Podcast 705: Pyloric Stenosis

Emergency Medical Minute ·

2021/08/17

Contributor: Neil Cella, MD Educational Pearls: Pylorus becomes hypertrophied and does not allow food or liquid to pass through to the duodenum tOccurs between the ages of 3 weeks to 3 months Classic presentation includes projectile nonbilious vomiting and palpable abdominal mass Ultrasound can visualize/diagnose pyloric stenosis and the treatment is surgical correction Be aware that electrolyte abnormalities and acid/base disturbances may occur References Garfield K, Sergent SR. Pyloric

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05:22

Podcast 704: Treatment of Pneumothorax

Emergency Medical Minute ·

2021/08/16

Contributor: Adam Barkin, MD Educational Pearls: Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up 316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms 15% of the conservative group required further intervention as determined by prespecified protocols 94.4% of the intervention group had resolution at 8

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09:24

Mental Health Monthly #8: Trauma-Informed Care

Emergency Medical Minute ·

2021/08/11

Contributor: Randi Libbon, MD The Core features of trauma-informed care include: Patient empowerment, choice and collaboration. This means educating patients and allowing patients to make choices about their care when possible. Collaboration helps to level the power differential between patients and providers through shared decision making. Safety and sensitivity: Developing health care settings and activities that ensure patients’ physical and emotional safety taking into account their diverse

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05:07

Podcast 703: Fever in Infants

Emergency Medical Minute ·

2021/08/10

Contributor: Neil Cella, MD Educational Pearls: <29 day old well-appearing febrile infant: 10% of patients <29 days old with a fever (>100.4) have an serious bacterial infection Most of these are UTIs, but also consider pneumonia and meningitis Requires CXR, LP, labs, and UA to work up cause of fever 29-60 day old well-appearing febrile infant: Can discharge without abx if CXR, lumbar puncture, labs and UA without signs of bacterial infection If UA is positive for UTI a LP is still

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02:55

Podcast 702: Paralytic Awareness

Emergency Medical Minute ·

2021/08/09

Contributor: Aaron Lessen, MD Educational Pearls: Known risk factors for being awake and paralyzed in the OR include only receiving IV medications, long-acting paralytics, and no formal monitoring system for being awake The ED-AWARENESS study, a prospective single-center study found 2.6% of patients with induced paralysis during mechanical ventilation were aware Rocuronium was a risk factor for developing awareness while paralyzed in this study Ensure adequate sedation during paralysis for

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03:09

Podcast 701: Elevated Blood Pressure Readings

Emergency Medical Minute ·

2021/08/03

Contributor: Aaron Lessen, MD Educational Pearls: Recent retrospective cohort study looked at elevated BP readings in the ED and correlation to underlying hypertension Large cohort of over 30,000 patients found that nearly 50% had an elevated blood pressure reading in the ED Less than 15% of patients with elevated BP readings in the ED were diagnosed with hypertension within 2 years Only 25% of patients with BP readings >160/100 were diagnosed with hypertension within 2 years Patients with an

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02:26

Podcast 700: Analgesics for Acute Musculoskeletal Pain

Emergency Medical Minute ·

2021/08/02

Contributor: Aaron Lessen, MD Educational Pearls: Recent RCT compared pain relief in patients receiving five medications for acute musculoskeletal pain Acetaminophen 1000mg/ibuprofen 400 mg Acetaminophen 1000mg/ibuprofen 800 mg Acetaminophen 300 mg/codeine 30 mg Acetaminophen 300mg/hydrocodone 5mg Acetaminophen 325mg/oxycodone 5mg No significant difference in pain relief at 1 and 2 hours between all of 5 groups References Bijur PE, Friedman BW, Irizarry E, Chang AK, Gallagher EJ. A Randomized

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