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Emergency Medical Minute

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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.

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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United States

Description:

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.

Language:

English


Episodes

Podcast # 488: Dalbavancin

7/15/2019
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Contributor: Nick Hatch, MD Educational Pearls: Dalbavancin (Dalvance®)is an antibiotic that can be used for skin and soft tissue infections, providing MRSA coverageIt cannot be used in other infections or sepsisDalbavancin may be appealing as a single dose lasts about 2 weeksExpense is currently a large barrier to usePatients with a vancomycin allergy will likely be allergic toDalbavancin as the two are related References Patel M, Smalley S, Dubrovskaya Y, Siegfried J, Caspers C, Pham V,...

Duration:00:03:47

Podcast # 487: Hunting for Epiglottitis

7/10/2019
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Contributor: Michael Hunt, MD Educational Pearls: Due to the efficacy of vaccination, epiglottitis is now more common in adults than childrenRisk factors include smoking and other immunocompromising co-morbidities, such as diabetesEpiglottitis can present with sore throat and fever, with potential rapid progression to respiratory distress and stridorDiagnosis can include x-ray to look for the “thumbprint sign," nasofiberoptics, and/or CTAntibiotics are mainstay of treatment but severe...

Duration:00:03:44

Podcast # 486: Morel Mushrooms

7/8/2019
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Contributor: Nick Hatch, MD Educational Pearls: True morel mushrooms are commonly foragedThe false morel mushroom (Gyromitra esculenta) looks similar to the true morel, but is toxicFalse morel mushroom toxicity can cause gastrointestinal symptoms as well as liver failure, rhabdomyolysis, and seizuresSeizures can be refractory to benzodiazepine therapy and may require use of vitamin B6 and propofol References Horowitz KM, Horowitz BZ. Gyromitra Mushroom Toxicity. [Updated 2019 May 12]....

Duration:00:04:12

Podcast # 485: Cerebellar Stroke

7/6/2019
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Contributor: Jared Scott, MD Educational Pearls: Cerebellar strokes make up a disproportionate number of missed or delayed diagnosis for stroke likely due to the subtle nature of the presentationCerebellar strokes can present with vomiting, dizziness, and ataxia. Unlike anterior circulation stroke, exam findings in a cerebellar stroke are ipsilateral to the lesion On neuro exam, findings may include:Dysmetria: lack of coordination with overshooting/undershooting intended position of...

Duration:00:05:02

Podcast # 484: Elevated ICP

7/4/2019
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Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma. While definite treatment is to remove the offending cause, there are emergency medicine Non-pharmacologic methods include elevating head of bed and removing noxious stimuliPharmacologic options include mannitol and hypertonic salineHypertonic saline is best delivered through a central line but not requiredBoth these agents benefit...

Duration:00:06:34

Podcast # 483: Dual Antiplatelet Therapy in TIA

6/28/2019
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Contributor: Don Stader, MD Educational Pearls: Antiplatelets include aspirin and clopidogrel, and are generally used for arterial clotting (MI, stroke)Anticoagulants such as coumadin, Xarelto, Eliquis are generally used for venous clotting (DVT/PE)Growing data suggests that dual antiplatelet therapy (aspirin+clopidogrel) is superior to aspirin alone in reducing stroke for diagnosed with TIA References: Kheiri B, Osman M, Abdalla A, Haykal T, Swaid B, Ahmed S, Chahine A, Hassan M, Bachuwa...

Duration:00:02:32

Podcast # 482: Tetracyclines and Hyperpigmentation

6/26/2019
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Contributor: Michael Hunt, MD Educational Pearls: Tetracycline antibiotics such as minocycline can cause greyish hyperpigmentationThis hyperpigmentation can sometimes be reversible but not alwaysMinocycline has been used for its effects in autoimmune and neurological diseases, where it is often taken chronically, which can lead to increased pigmentation References La Placa M, Infusino SD, Balestri R, Vincenzi C. Minocycline-Induced Blue-Gray Discoloration. Skin Appendage Disord. 2017...

Duration:00:03:48

Podcast # 481: Medical Errors and Cognitive Bias

6/21/2019
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Contributor: Peter Bakes, MD Educational Pearls: While there are many different types of medical error, one of the most common errors in emergency medicine is failure to diagnoseSystematic error in thinking that negatively affects judgementMedical errors are often driven by cognitive biases, which include anchoring, attribution, and availability Anchoring bias occurs when early information leads to premature closure on a single diagnosis. There is subsequent failure to consider alternative...

Duration:00:06:01

Podcast # 480: Inhalant Abuse

6/19/2019
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Author: Sam Killian, MD Educational Pearls: Abuse occurs by breathing in volatile substances such as solvents, glues, paints, butane, and propaneInhalants are generally depressantsEstimated that 100-125 people die every year in the US from acute inhalant abuse.Short-term effects include memory impairment, slurred speech, diplopia, seizures, and cardiac arrhythmiasLong term effects include renal dysfunction, neuropathy, blindness and cognitive bluntingEvaluation includes a detailed lung...

Duration:00:04:01

Podcast # 479: Clots and Pregnancy

6/17/2019
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Author: Nick Hatch, MD Educational Pearls: Pregnancy is a hypercoagulable state, which predisposes women to venous thromboembolism, but also elevates levels of circulating d-dimerA recent study evaluated the YEARS protocol in combination of adjusted d-dimer cutoffs in pregnant women to evaluate for DVT and PEUsing this protocol, only 1 DVT was missed. No PE’s were missed.This protocol has growing evidence as an option in pregnant women in whom you must rule out a DVT/PE but more validating...

Duration:00:03:39

Podcast # 478: Psychedelics and Depression

6/14/2019
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Author: Chris Holmes, MD Educational Pearls: Hallucinogenic drugs have been in use since ancient times for both medical and recreational purposesAyahausca is an ancient psychedelic with origins in Bolivia that causes intense vomiting followed by a psychedelic experienceThis and other hallucinogens are gaining gaining interest for their use in depression with some startling positive initial results...

Duration:00:03:09

Podcast # 477: Postpolypectomy Electrocoagulation Syndrome

6/12/2019
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Author: Nick Hatch, MD Educational Pearls: Postpolypectomy electrocoagulation syndrome (PES) is a rare complication of polypectomy and electrocautery during colonoscopyOccurs when cautery causes transmural thickening from a contact burnPatients can present as if they have peritonitis, with guarding, leukocytosis, fever, etc.CT is the imaging of choice mainly to evaluate for bowel perforation as PES may not be seen on imagingTreatment is often with antibiotics and supportive care - in...

Duration:00:03:44

Podcast # 476: Evidence for Patient Satisfaction

6/5/2019
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Author: Dylan Luyten, MD Educational Pearls: Actual wait times are weakly correlated to patient satisfaction but the difference between perceived/expected wait times and actual wait times isstrongly correlatedHaving others in the room or with the patient while they wait also has a positive effectUnder-promising and over-delivering can result in better patient experienceManaging up others and services provided also is demonstrated to improve satisfactionPerceived time with health care...

Duration:00:04:24

Podcast # 475: Orthostatic Vital Signs and Syncope

6/2/2019
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Author: Michael Hunt, MD Educational Pearls: A recent study evaluated the relationship between abnormal orthostatic vital signs and serious outcomes within 30 days in patients over 60 presenting to the ED with syncopeOf the roughly 2000 patients enrolled, about ⅓ had abnormal orthostatic vital signsThere was no statistically significance between orthostatic vital signs and serious outcomes in 30 days Editor's note: study used a composite end-point of multiple serious...

Duration:00:02:54

Podcast # 474: Obesity Hypoventilation Syndrome

5/29/2019
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Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liverObesity hypoventilation syndrome (OHS) is an important and common cause of right heart failure. Nighttime hypoventilation leads to pulmonary hypertension, causing right heart strain followed by right heart failureOHS criteria includes obesity, sleep disordered breathing, and alveolar hypoventilation (PaCO2 > 45 mmHg)The causes of OHS are multifactorial, and...

Duration:00:09:16

Podcast # 473: Direct to Consumer Antibiotics

5/24/2019
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Author: Sam Killian, MD Educational Pearls: A recent study inPediatricscompared the rates of antibiotic prescriptions for acute respiratory infections (ARIs) between direct to consumer (DTC) telemedicine, urgent care, and primary care providersAmong the nearly 530,000 visits studied, the rate of antibiotic prescription was 52%, 42% and 31% for telemedicine, urgent care, and primary care providers, respectivelyNearly 4/10 antibiotic prescriptions from telemedicine visits were not indicated...

Duration:00:03:05

Podcast # 472: SMART Crystalloids

5/23/2019
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Author: Gretchen Hinson, MD Educational Pearls: In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacksBalanced crystalloids such as lactate Ringer’s may be preferable in more critically ill populations References Yau YW, Kuan WS. Choice of crystalloids in sepsis: a conundrum waiting to be solved. Ann Transl Med. 2016;4(6):121. doi:10.21037/atm.2016.02.09 Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids...

Duration:00:05:44

Podcast # 471: Cyclic Vomiting

5/21/2019
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Author: Don Stader, MD Educational Pearls: Cyclic vomiting syndrome (CVS) is different than cannabis hyperemesis syndrome (CHS). It is important to differentiate the two.CHS is thought to be caused by activation of THC receptors in the gutCVS is associated with migraines and therefore responds to similar medicationsOlanzapine (Zyprexa) is an alternative to haloperidol (Haldol)Amitriptyline, as well as anti-epileptics can be used to prevent CVSOpioids worsen CVS References Lapoint J, Meyer...

Duration:00:04:15

Podcast # 470: Zofran and Pregnancy

5/17/2019
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Author: Jared Scott, MD Educational Pearls: Ondansetron (Zofran) is one of the latest drugs that has had concerns raised about side effects, particularly in pregnancy2018 study probed two birth defect databases to assess increases in 51 major birth defects with increased exposure to ondansetronOnly two of the 51 had even a modest increase, which is unclear in causation (cleft palate and renal agenesis)When administering ondansetron (or any drug) to pregnant women, be able to discuss any...

Duration:00:03:33

Podcast # 469: Go PO

5/16/2019
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Author: Dave Rosenberg, MD Educational Pearls: Nothing by mouth (NPO) status routinely used before surgery to reduce the theoretical risk of aspirationHowever, surgery poses a large physiological stress. Calories and fluid are needed to overcome stresses like thesePatients who drank 1/2 strength Gatorade up to 2 hours before surgery did better than those who did not References Alyssa Cheng-Cheng Zhu, Aalok Agarwala, Xiaodong Bao. Perioperative Fluid Management in the Enhanced Recovery...

Duration:00:03:36