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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.

health & fitness medicine

All Episodes

05:32

Podcast 633: Pathologic Femur Fractures

Emergency Medical Minute ·

2021/01/19

Contributor: Jared Scott, MD Educational Pearls: Pathologic bone fractures occur due to weakened bones from chronic disease and with less force when compared to non-pathologic fractures Can be due to bone tumors, bone cysts, infections (osteomyelitis), osteogenesis imperfecta, Paget's disease of bone, and multiple myeloma Have moth bitten or lytic appearance and you can sometimes see the periosteum peeling away from the bone References Angelini A, Trovarelli G, Berizzi A, Pala E, Breda A, Maraldi

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06:32

Podcast 632: Neonatal Jaundice

Emergency Medical Minute ·

2021/01/18

Contributor: Jared Scott, MD Educational Pearls: Bilirubin is natural breakdown product of red blood cells but can be neurotoxic if levels become too high Fetal red blood cells are fragile and break down easier, leading to higher bilirubin levels in neonates Immature livers and increased intestinal absorption from sterile bowels also contribute to elevated levels and jaundice in all neonates Other risk factors for neonatal jaundice include: temperature instability, poor feeding, hypoxia at birth,

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04:37

Pharmacy Phriday #7: Bactrim Adverse Events

Emergency Medical Minute ·

2021/01/15

Contributor: Cheyenne Bean, PharmD Educational Pearls: Bactrim (TMP-SMX) is a sulfa antibiotic used for a number of infections but can have untoward effects. Hypoglycemia can be induced by the sulfa component of Bactrim, which binds receptors in the pancreas causing insulin to be secreted, dropping blood sugar levels. Oral diabetic medications, specifically sulfonylureas, when taken with Bactrim most often lead to these hypoglycemic episodes. Hyperkalemia can be induced by Trimethoprim by

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05:00

Podcast 631: UK COVID-19 Mutation

Emergency Medical Minute ·

2021/01/13

Contributor: Gretchen Hinson, MD Educational Pearls: Viruses mutate frequently and a new variant of COVID has been found in the United Kingdom. Mutations typically occur due to transcription errors during virus replication leading to slight changes in the virus which can alter its virulence, and this UK mutation has shown more infectivity. The UK variant was first identified on 9/20/20 and sequenced in October The variant has a mutation of the spike protein with increased receptor binding capacity,

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05:43

Podcast 630: Evolution of an STEMI

Emergency Medical Minute ·

2021/01/12

Contributor: Peter Bakes, MD Educational Pearls: Hyperacute T waves can occur immediately and typical last less than an hour Hyperacute T waves are typically broader than peaked T-waves, which are associated with hyperkalemia ST elevation which usually starts within an hour of the inciting event and can last up to a few days, and often follows the hyperacute T-waves Q waves can begin at the time ST elevation begins and can remain permanently T waves can invert before normalizing again days

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04:01

Podcast 629: Inferior STEMI

Emergency Medical Minute ·

2021/01/11

Contributor: Jared Scott, MD Educational Pearls: EKGs look at different angles, or vectors, of the heart’s electrical conduction as it travels through the heart. Knowing how to read these vectors is essential in diagnosing locations of cardiac pathologies Leads II, III, and aVF follow an inferior path, so ST elevation in those leads indicates inferior involvement Major complications more common with inferior STEMIs can include: hypotension which can be made worse by nitroglycerin Severe

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05:15

Podcast 628: ST Elevation

Emergency Medical Minute ·

2021/01/05

Contributor: Peter Bakes, MD Educational Pearls: STEMI criteria is not just 1mm elevation in contiguous leads 1.5 mm in V2-V3 for women 2.0 mm in V2-V3 for men 2.5 mm in V2-V3 for men under 40 Inferior MI typically have ST elevation in leads II, III and aVF Usually inferior MI’s show reciprocal changes (ST depression) in the lateral leads. Lateral MI typically elevation in V5, V6, I, and aVL Anterior MI show elevation in leads V1-4 Right sided MIs have mixed pattern, showing elevation in

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03:01

Podcast 627: Oxygen Like It’s Hot

Emergency Medical Minute ·

2021/01/04

Contributor: Aaron Lessen, MD Educational Pearls: High flow nasal cannula (HFNC) has become more utilized with COVID pandemic Multiple studies have shown this method improves both oxygenation and ventilation Newer studies have shown the respiratory benefit of HFNC vs normal oxygen in patients suffering from CHF and those with do not intubate orders who are experiencing respiratory distress. Heated high flow is another option to provide ventilator and oxygen support to patients who either do not

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06:42

Pharmacy Phriday #6: Tik Tok Benadryl Challenge and...

Emergency Medical Minute ·

2021/01/01

Contributor: Ruben Marrero-Vasquez, PharmD Educational Pearls: ACEP and FDA have both issued warnings about the viral Tik Tok Benadryl (diphenhydramine) challenge where individuals voluntarily overdose on diphenhydramine which can cause fatal toxicity Diphenhydramine is typically dosed at 0.5-1 mg/kg in pediatric patients Q4-6 PRN and carries a fatal dose of 20-40 mg/kg but anywhere from 3-5x recommended dose does can cause toxicity Diphenhydramine toxicity causes both central and peripheral

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16:48

Mental Health Monthly #6: Suicide Assessment

Emergency Medical Minute ·

2020/12/30

EMM is excited to welcome back the hosts of Millennial Mental Health Channel podcast to explain the key points of a robust suicide assessment in the ED. Dr. Justin Romano is a third year psychiatry resident in Omaha, Nebraska and Eddie Carrillo is a licensed mental health therapist currently working at partial hospitalization and IOP eating disorder program in Portland, Oregon. Their podcast Millennial Mental Health Channel seeks to explore the world of mental health from their two professional

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04:06

Podcast 626: Updated Gonorrhea Treatment

Emergency Medical Minute ·

2020/12/29

Educational Pearls: The CDC has made new formal recommendations for treating Gonorrhea due to increasing resistance to Rocephin and Azithromycin. New recommendations: Confirmed gonorrhea: Ceftriaxone 500 mg once Empiric treatment: Ceftriaxone 500 mg once followed by 7 days Doxycycline 100 mg BID No longer using Azithromycin due to high resistance Second line: Gentamycin IM Cefixime 800 mg oral Pharyngeal involvement has high resistance rates to second line agents and ceftriaxone is strongly

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02:17

Podcast 625: High Altitude Cerebral Edema (HACE)

Emergency Medical Minute ·

2020/12/28

Contributor: Tom Seibert, MD Educational Pearls: High altitude cerebral edema (HACE) is the end stage of acute mountain sickness and is diagnosed when patients develop neurologic dysfunction, ataxia, and altered mental status. The pathophysiology of HACE is thought to be due to increased cerebral blood flow and increased capillary permeability causing vasogenic edema and brain swelling HACE is linked to extreme altitude Rapid descent should be done as soon as possible for this potentially fatal

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03:17

Podcast 624: Timing and Tips on Sepsis

Emergency Medical Minute ·

2020/12/22

Contributor: Don Stader, MD Educational Pearls: Time can be an important factor in outcomes regarding sepsis including mortality Emphasis has grown on early administration of antibiotics and IV fluids in sepsis However, early initiation of vasopressors for hypotensive patients may have significant mortality benefit as well References Hayden GE, Tuuri RE, Scott R, et al. Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED. Am J Emerg Med. 2016;34(1):1-9.

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04:39

Podcast 623: Acute Mountain Sickness

Emergency Medical Minute ·

2020/12/21

Contributor: Tom Seibert, MD Educational Pearls: Acute Mountain sickness (AMS) can cause headache along with fatigue, nausea, vomiting, insomnia Typically occurs above 6500 feet (not 65,000) in elevation Acclimation to altitude can help prevent symptoms if not treated, AMS can advance to severe illness involving cerebral or pulmonary edema. Mild symptoms can be managed with rest but more severe symptoms will require descent, oxygen, acetazolamide and steroids Acetazolamide can be used as both a

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04:56

Podcast 622: High Altitude Pulmonary Edema (HAPE)

Emergency Medical Minute ·

2020/12/15

Contributor: Thomas Seibert, MD Educational Pearls: High Altitude Pulmonary Edema (HAPE) typically occurs 2-4 days after arriving at elevation Symptoms include: Fatigue Dyspnea Cough Treatment includes: Descent to lower elevation Oxygen supplementation Nifedipine Caused by sympathetic stimulation from hypobaric hypoxic exposure, causing uneven pulmonary vasculature constriction and when paired with a leaky endothelium, pulmonary edema. #science References Swenson ER, Bärtsch P

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03:22

Podcast 621: Pediatric Psychosis

Emergency Medical Minute ·

2020/12/14

Contributor: Aaron Lessen, MD Educational Pearls: Schizophrenia typically doesn’t present until age 13 and has a prodrome Prodrome includes months of gradual changes in behavior, starting with negative symptoms and progressing to positive symptoms Negative symptoms include losing concentration, poor memory, poor school performance, and personality changes Positive symptoms include hallucinations, which tend to be more visual in children Sudden changes mimicking psychiatric illness should raise

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19:39

Pharmacy Phriday #5: COVID-19 Vaccine for Pregnant Women

Emergency Medical Minute ·

2020/12/11

Contributors: Rachael Duncan, PharmD and Sean McCullough, PharmD Educational Pearls: A 2019 Report by the National Women’s Law Center: Most common occupations for pregnant workers are elementary and middle school teachers, registered nurses, and nursing/psychiatric/home health care aides. This raises the question: Should pregnant women, specifically front-line workers, get the Covid-19 vaccine? According to the FDA, there is currently not enough data to make a conclusion about the safety of the

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03:53

Podcast 620: Prolactin and Seizures

Emergency Medical Minute ·

2020/12/08

Contributor: Aaron Lessen, MD Educational Pearls: Serum prolactin levels can be used to help differentiate epileptic seizures from non-epileptic seizures It is also released and elevated after epileptic seizures but not non-epileptic seizures A level must be checked 10-20 minutes after the episode and if possible a next day level should be checked to establish a baseline Levels can also be raised after a syncopal event Not the most useful ED also due to the long turn around time EEG will remain

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04:17

Podcast 619: Other Uses for Zyprexa

Emergency Medical Minute ·

2020/12/07

Contributor: Don Stader, MD Educational Pearls: Zyprexa (olanzapine) is a second generation antipsychotic with multiple other uses Excellent for treating nausea in patients undergoing chemotherapy or with THC hyperemesis syndrome Helps with the psychological and emotional aspect of pain Effective in treatment of headaches Can be given under the tongue Fewer incidences of dystonic reactions compared with first generation antipsychotics Patients using anti-dopaminergic should not receive

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04:18

Podcast 618: Treating Opiate Side Effects

Emergency Medical Minute ·

2020/12/01

Contributor: Don Stader, MD Educational Pearls: Majority of patients experience side effects while taking opioids Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol) Itching from opiates isn’t histamine

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