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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

03:07

Podcast 699: Pediatric Fingernail Avulsions

Emergency Medical Minute ·

2021/07/28

Contributor: Aaron Lessen, MD Educational Pearls: Traditionally, fingernails were replaced after avulsion using sutures Sometimes artificial material was placed when the fingernail was not available Recent study evaluated treatment of fingernail avulsions pediatric patients by replacing the nail versus cleaning and putting a non-adhesive dressing No difference in the aesthetics or patient satisfaction with the new fingernail between the two treatment groups References Seiler M, Gerstenberg A,

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02:36

Podcast 698: Empathy, Burnout, and Patient Satisfaction

Emergency Medical Minute ·

2021/07/27

Contributor: Aaron Lessen, MD Educational Pearls: Survey of EM physicians to self-report empathy and burnout levels and correlated with patient satisfaction scores Patient satisfaction was not affected by what the physicians thought about their level of empathy or burnout Patient satisfaction was affected by the patient’s perception of empathetic behavior by the physician References Byrd J, Knowles H, Moore S, et al. Synergistic effects of emergency physician empathy and burnout on patient

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03:27

Podcast 697: Kounis Syndrome

Emergency Medical Minute ·

2021/07/26

Contributor: Aaron Lessen, MD Educational Pearls: Kounis syndrome is an allergic acute coronary syndrome Triggers include medications (antibiotics), insect bites, or other common allergens Believed to be due to mast cell activation, inflammatory cytokines, and platelet activation causing coronary vasospasm or plaque rupture in setting of existing atherosclerosis Consider Kounis syndrome in the setting of chest pain in anaphylaxis Treatment involves treatment of allergic reaction, although

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04:46

Podcast 696: ST Elevation and Differential Diagnoses

Emergency Medical Minute ·

2021/07/21

Contributor: Peter Bakes, MD Educational Pearls: ST elevation clinical guidelines for myocardial infarction include: 2.5 mm elevation for males <40 in V2 and V3 2 mm elevation in males >40 in V2 and V3 1.5 mm elevation for females in V2 and V3 1 mm elevation in 2 or more contiguous leads (not V2 or V3) Differential diagnosis of ST elevation includes, but is not limited to: STEMI Electrolyte abnormalities Pericarditis/myocarditis Brugada syndrome LVH Bundle branch blocks Ventricular aneurysm

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03:01

Podcast 695: Einstein and Cellophane

Emergency Medical Minute ·

2021/07/20

Educational Pearls: Albert Einstein had chronic abdominal pain as a middle-aged man Dr. Rudolph Nissen, founder of the Nissen fundoplication, performed exploratory surgery for this pain and found an abdominal aortic aneurysm (AAA) The only treatment for an AAA at that time was to wrap the vessel in cellophane, causing a fibrotic response to prevent rupture Einstein died 7 years after this surgery, likely from his leaking abdominal aortic aneurysm References Cervantes Castro J. Albert Einstein y su

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04:52

Podcast 694: Complete Heart Block

Emergency Medical Minute ·

2021/07/19

Contributor: Nick Hatch, MD Educational Pearls: Complete heart block or 3rd degree atrioventricular (AV) block is diagnosed via EKG and occurs when electrical signals from the sinoatrial (SA) node are blocked from reaching the ventricles via the AV node and AV bundles P waves and QRS complexes are independent Often QRS rate is around 40 The rate is slow because the ventricular purkinje fibers have an intrinsic rate of 20-40 bpm, whereas the SA node has an intrinsic rate of 60-100 bpm Treatment is

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07:45

Podcast 693: Humerus Fractures

Emergency Medical Minute ·

2021/07/14

Contributor: Nick Tsipis, MD Educational Pearls: Humerus fractures can be characterized as proximal, midshaft, and distal fractures Proximal humerus fracture is the second-most common fracture in elderly patients Primary complication is with the axillary nerve and axillary artery Vast majority are managed nonoperatively with a sling, reduction usually not indicated Women comprise 70% of proximal humerus fractures, often secondary to fall with osteoporosis Midshaft humerus fractures are more

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04:13

Podcast 692: Pelvic Fractures

Emergency Medical Minute ·

2021/07/13

Contributor: Peter Bakes, MD Educational Pearls: Pelvis is comprised of the iliac, ischium, and sacrum Three mechanisms for pelvic fractures by Young-Burgess Classification Anterior-posterior compression causing open-book pelvic fractures that can be complicated by retroperitoneal bleeding or urethral injury Lateral compression causing rami fractures Vertical sheer causing offset of sacroiliac joint or sacrum Mechanically stable pelvic ring fractures can be conservatively treated with weight

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02:45

Podcast 691: TXA in Head Bleeds

Emergency Medical Minute ·

2021/07/12

Contributor: Ricky Dhaliwal, MD Educational Pearls: CRASH 3 Trial looked at over 12,000 patients with traumatic intracranial bleeds, randomizing patients to a therapy with TXA or standard of care without TXA Dosing was 1 gram over 10 min for loading dose and then an infusion of 1 gram over 8 hours Found Improvement in survival and neurologic outcomes when patient received TXA within 3 hours References CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive

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03:54

Podcast 690: Rectal Oxygen. Nice,

Emergency Medical Minute ·

2021/07/07

Contributor: Chris Holmes, MD Educational Pearls: In the 1700s, boxes lined the River Thames to pump smoke up the rectum to resuscitate people who had been found unconscious in the river Sea cucumbers can extract oxygen through their rectum Perflourocarbon, a liquid that can become oxygenated, provided rectally was able to oxygenate pigs and mice in a recent study References Okabe R, Chen-Yoshikawa T, Yoneyama Y, et al. Mammalian enteral ventilation ameliorates respiratory failure. Clinical and

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04:23

Podcast 689: Peri-Intubation Hypotension

Emergency Medical Minute ·

2021/07/06

Contributor: Ricky Dhaliwal, MD Educational Pearls: Hypotension in patients requiring intubation should be resuscitated as much as possible While intubating, the negative inspiratory pressure goes away decreasing cardiac preload and worsening hypotension Phenylephrine can be given via push doses to increase blood pressure from alpha agonism For sedation, avoid propofol with hypotension and opt for etomidate or ketamine References April MD, Arana A, Schauer SG, et al. Ketamine Versus Etomidate

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02:39

Podcast 688: tPA Before Thrombectomy

Emergency Medical Minute ·

2021/07/05

Contributor: Aaron Lessen, MD Educational Pearls: DEVT Trial, a recent non-inferiority study, looked at giving tPA prior to endovascular thrombectomy and was stopped early because there was no benefit shown to giving tPA before this intervention Coupled with the SKIP and DIRECT MT trials corroborating these findings, it appears that giving tPA prior to thrombectomy is not indicated Whether patients should receive tPA prior to transfer for thrombectomy (i.e. they are in a rural healthcare setting)

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04:44

Podcast 687: STI Complications

Emergency Medical Minute ·

2021/06/30

Contributor: Jared Scott, MD Educational Pearls: PID (pelvic inflammatory disease) occurs when the infection ascends into the uterus Tubo-ovarian abscess occurs when the infection ascends to the fallopian tubes Fitz-Hugh-Curtis syndrome occurs when the infection enters the peritoneum and causes peritoneal inflammation with peri-hepatic inflammation These conditions require GYN consultation and often more robust antibiotic therapy for treatment References Lareau SM, Beigi RH. Pelvic inflammatory

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03:21

Podcast 686: Vaginal Self Swabs

Emergency Medical Minute ·

2021/06/29

Contributor: Jared Scott, MD Educational Pearls: Recent study evaluated vaginal self swab testing for STIs to determine if they are equally sensitive to provider-obtained swab 515 patients consented to both tests and 95% agreement was found between the two methods of obtaining samples 75% of participants who preferred this over the pelvic exam, although some patients were concerned they did not perform the self swab correctly Consider vaginal self swab with proper coaching as an option for patients

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10:21

Podcast 685: Cultural Sensitivity with LGBTIQ+ Patients

Emergency Medical Minute ·

2021/06/28

Contributor: Dr. Nick Gorton, MD Educational Pearls: Use transgender people’s correct names and pronouns, the Russell study found a 56% reduction in suicide behavior with chosen name usage ⅕ to ½ of transgender people report they avoided seeking care in the ED because of fear of transphobic treatment Understanding the definitions of gender identity, gender expression, assigned sex at birth, physical attraction, and emotional attraction are necessary for improving treatment of the LGBTIQ+ community

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06:13

Podcast 684: Acidosis

Emergency Medical Minute ·

2021/06/23

Contributor: Nick Tsipis, MD Educational Pearls: pH <7.35 = acidemia; pH>7.45=alkalemia If pH low and pCO2 high, indicates a respiratory acidosis If pH low and pCO2 low, indicates metabolic acidosis After determining type of acidosis, check bicarb to determine compensation for acidosis and check electrolytes to calculate anion gap Metabolic acidosis can present with tachypnea (Kussmaul breathing) and hypotension due to loss of catecholamine function and suboptimal cardiac function at low pH Treat

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05:15

Podcast 683: Zofran vs. Haldol for Cannabinoid...

Emergency Medical Minute ·

2021/06/22

Contributor: Jared Scott, MD Educational Pearls: Around 30 patients with cannabinoid hyperemesis syndrome (CHS) randomized treatment in three arms with 8mg Zofran, Haldol 0.05 mg/kg, and Haldol 0.1 mg/kg Haldol arms performed better on all measures compared to Zofran Extrapyramidal symptoms were significantly higher in the Haldol group than Zofran, especially the high-dose Haldol group References Ruberto AJ, Sivilotti MLA, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus

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06:37

Podcast 682: Snake Bites

Emergency Medical Minute ·

2021/06/21

Contributor: Gretchen Hinson, MD Educational Pearls: Pit vipers include cottonmouths, rattlesnakes, and copperheads All have folding long fangs, triangular face, and elliptical pupils About 5,000 snakebites per year reported to Poison Control Initially develop a local reaction (swelling, bruising, pain, bullae) Complications can include 25% of snake bites result in no envenomation (dry bites) 20% of bites have serious side-effects, which can include hematologic, cardiovascular, neurologic

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05:04

Podcast 681: Internal Hernias

Emergency Medical Minute ·

2021/06/16

Contributor: Adam Barkin, MD Educational Pearls: Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery CT is very >90% sensitivity and specific

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04:01

Podcast 680: Coronary Artery Dissection

Emergency Medical Minute ·

2021/06/15

Contributor: Adam Barkin, MD Educational Pearls: Spontaneous coronary artery dissection (SCAD) is the most common cause of acute MI in women under 50 years old Risk factors include fibromuscular dysplasia, extreme exercise, stress, pregnancy, and recent birth Diagnosed in cath lab but medically managed and usually do not get a stent Treated with dual antiplatelet therapy and beta-blockers References Yip A, Saw J. Spontaneous coronary artery dissection-A review. Cardiovasc Diagn Ther

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