Emergency Medical Minute

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**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.

Latest Episodes:

Podcast 1013: Thoracotomy Indications Jul 20, 2026

Show notes

Contributor; Taylor Lynch, MD

Educational Pearls:

Thoracotomy

Thoracotomy is used in traumatic cardiac arrest to replace conventional CPR with direct access to the chest.
Goals include identifying and controlling reversible causes of bleeding, prioritizing blood flow to the heart and brain, and performing open cardiac massage.

Trauma categories

Penetrating trauma: Gunshot wounds and stab wounds.

Has a higher chance of survival because the injury may be localized and directly repairable.
Cardiac stab wounds may have the highest survivability because the defect can be visualized, repaired, and treated with blood administration.

Blunt trauma: Motor vehicle collisions and falls from height.

Has a much lower chance of survival.

Western guidelines

EMS must witness the patient lose pulses.
Penetrating trauma: CPR for less than 15 minutes.
Blunt trauma: CPR for less than 10 minutes.
Survival decreases to essentially zero beyond these time limits.

Eastern guidelines

Focus on the presence of signs of life in blunt or penetrating trauma.
Signs of life may include:

Pupillary response.
Measurable blood pressure.
Purposeful movement.

Patient selection

Thoracotomy should only be performed when the patient has a reasonable chance of survival.
It is a highly morbid procedure with significant occupational risks, including needlestick injury.
Appropriate patient selection and timing are essential.

Procedure

Begin on the left side of the chest.
Cross-clamp the aorta to restrict blood flow below the heart and prioritize circulation to the heart and brain.
Identify and repair visible sources of bleeding involving structures such as the heart or lungs.
Perform open cardiac massage as the equivalent of CPR.
ACLS medications may still be administered.

References:

Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006;1:4. Published 2006 Mar 24. doi:10.1186/1749-7922-1-4
Rhee, Peter M. ; Acosta, Jose ; Bridgeman, Amy et al. / Survival after emergency department thoracotomy : Review of published data from the past 25 years. In: Journal of the American College of Surgeons. 2000 ; Vol. 190, No. 3. pp. 288-298.
Nunn, Andrew ; Prakash, Priya ; Inaba, Kenji et al. / Occupational exposure during emergency department thoracotomy : A prospective, multi-institution study. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 78-84.
Burlew CC, Moore EE, Moore FA, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359-1363. doi:10.1097/TA.0b013e318270d2df
Seamon MJ, Haut ER, Van Arendonk K, et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;79(1):159-173. doi:10.1097/TA.0000000000000648

Summarized by Steven Fujaros NREMT | Edited by Steven Fujaros & Ahmed Abdel-Hafiz, NREMT-P

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Podcast 1012: Meth Sedation Jul 13, 2026

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Agitated patients who are intoxicated with methamphetamine pose a unique challenge when selecting a sedative to counter their symptoms. Is there a superior medication?

A recent study compared the efficacy of commonly used medications for methamphetamine-induced agitation in the emergency department.

The study compared IM Droperidol 5mg, IM Olanzapine 10mg, IM Midazolam 5mg, and IM Lorazepam 2mg.
The study concluded that Droperidol, Olanzapine, and Midazolam performed similarly, with a median time to adequate sedation of 15 minutes.
Lorazepam took the longest, with a median time of 30 minutes to achieve adequate sedation.

Patients who received Lorazepam also required rescue medication more frequently after the initial dose.

Key takeaway: Droperidol, Olanzapine, and Midazolam may be more effective than Lorazepam for treating methamphetamine-induced agitation.

References:

Martel M, Klein LR, Cole JB, et al. Intramuscular droperidol, olanzapine, midazolam, or lorazepam to treat methamphetamine intoxication in the emergency department. Am J Emerg Med. 2021;49:142-148. doi:10.1016/j.ajem.2021.05.045

Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

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Podcast 1011: Creepy Crawlies Jul 06, 2026

Show notes

Contributor: Meghan Hurley, MD

Educational Pearls:

What animal is the most lethal to humans?

Depending on how we define lethal, and animal, this answer is actually not straight forward.

Globally and in the U.S. the most lethal animal is humans, accounting for ~436,000 to ~20,000 deaths (homicides) per year on average respectively.
In the United States the most lethal animal is of the Hymenoptera order (bees, wasps, and hornets). It accounts for approximately ~60 deaths per year from anaphylaxis. Globally the number is harder to track, but is estimated between 250–3,800 deaths globally annually.
Globally the most lethal animal is venomous snakes, accounting for between 60,000-150,000 per year (whereas in the United States this number is closer to ~5).
Mosquitos, as a vector however for the pathogens they transmit, out rank all as the most lethal globally (excluding humans).

What are the key take-aways for each insect discussed in this episode?

Mosquitos:

In the United States, of lesser concern. Can potentially transmit West Nile Virus in the United States. Otherwise, treatment for general mosquito bites is topical antihistamines and over the counter steroid creams.

Hymenoptera order (bees, wasps, and hornets):

Distributed throughout the US, and can also live in the ground.
Bees lose their stinger during a sting. Whereas wasps do not and can sting multiple times.
Typically stings are just localized for symptoms (pain and swelling) but can become anaphylactic.

Treat with IM Epinephrine as the first line. Consider bronchodilators from bronchospasms.

Multiple stings (around ~100), can cause end organ damage and rhabdomyolysis outside of just anaphylaxis alone. Require more aggressive management.

Fire Ants:

Behave similar to bees (in swarm mentality), but have differing venoms. Can also cause global symptoms.

Black Widow:

No deaths from Latrodectus hesperus (Western Black Widow) recorded in the United States. There are 3 deaths globally from widow species. Two from Madagascar, and one from a Mediterranean species of widow.
Debate in the toxicology community about use of the antivenom, which may account for more deaths than the bite itself.
Black Widow bites are typically painful. Which is different from bites from recluse species.

Brown Recluse:

Rare in Colorado
Typically painless bite, that creates a center necrotic eschar.
Tend to also not be lethal.

Bed Bugs

Typically harmless and more of a nuisance to have. Can cause localized infections.
Bite presents in a "Breakfast, Lunch, and Dinner" formation (i.e. linear 2-3 or more bites as the bug tracks and feeds on skin).

Will feed primarily on exposed skin.

The biggest concern is ensuring no cross contamination from patient to provider or facility.
Bed bug bite delivers a small amount of local anesthetic, which can make them hard to detect.

References

Haskell MG, Langley RL. Animal-Encounter Fatalities, United States, 1999-2016: Cause of Death and Misreporting. Public Health Rep. 2020;135(6):831-841. doi:10.1177/0033354920953211
Herness J, Snyder MJ, Newman RS. Arthropod Bites and Stings. AFP. 2022;106(2):137-147.
GBD 2019 Snakebite Envenomation Collaborators. Global mortality of snakebite envenoming between 1990 and 2019. Nat Commun. 2022;13(1):6160. doi:10.1038/s41467-022-33627-9
Wei YL, Wu Z, Li RL, Tang F. Review of selected mosquito-borne diseases: arboviruses (dengue, chikungunya, Zika, West Nile, Japanese encephalitis, yellow fever) and parasitic diseases (malaria, lymphatic Filariasis). Front Public Health. 2025;13:1712094. doi:10.3389/fpubh.2025.1712094
Forsberg K, Sheats KJ, Blair JM, et al. Surveillance for Violent Deaths - National Violent Death Reporting System, 50 States, the District of Columbia, and Puerto Rico, 2022. MMWR Surveill Summ. 2025;74(5):1-42. doi:10.15585/mmwr.ss7405a1

Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P

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Podcast 1010: First Pass Intubation Success Jun 29, 2026

Show notes

Contributor: Travis Barlock, MD

Educational Pearls:

First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.

Complication rate for patients intubated on the first pass is 14%
Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt

How to improve likelihood of first-pass success:

Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71%
Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without
Use a Checklist mnemonic (SOAPME)

Suction – On, ready, and within reach
Oxygen – Patient is preoxygenated
Adjuncts – Oral/nasal adjuncts and BVM ready
Positioning - Patient positioned properly; consider obesity, using semi-Fowler/head-up positioning
Medications – Rapid sequence intubation (RSI), sedation, vasopressor, and other medications prepared as necessary
Equipment – Laryngoscope (blade), tube, bougie/stylet, syringe, scalpel/cric kit, others ready as necessary

References

Sakles, J.C., Chiu, S., Mosier, J., Walker, C. and Stolz, U. (2013), The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med, 20: 71-78. https://doi.org/10.1111/acem.12055
Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine. 2023;389(5). doi:https://doi.org/10.1056/nejmoa2301601
Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179–2189. doi:10.1001/jama.2018.6496
‌Turner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001/jamanetworkopen.2020.9278
Turner, Joseph S et al. "Feasibility of upright patient positioning and intubation success rates At two academic EDs." The American journal of emergency medicine vol. 35,7 (2017): 986-992. doi:10.1016/j.ajem.2017.02.011

Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P

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On the Streets- Zero to Rodeo Jun 22, 2026

Show notes

Dan Orbidan, OMS-II and Dr. Travis Barlock, MD discuss a real out of hospital call. This episode covers the implications of a pharmacologically abnormal patient presentation and the pre and post hospital considerations for patient management and care.

Carepoint Journal Club- Neurology Jun 15, 2026

Show notes

Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

Podcast 1009: Prevention for Recurrent UTI Jun 08, 2026

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

UTIs are commonly seen in older women

We often see them taking long-term prophylactic antibiotics because of common recurrence.
Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment.

UTI signs and symptoms

Burning sensation when urinating
Strong urge to urinate
Urinating often and passing small amounts of urine.
Pelvic pain

There are currently more guidelines and studies on treatments to prevent these recurrent UTIs in women that we can start in the Emergency Department.

Vaginal estrogen has been shown to significantly reduce this issue of recurrence.

Very simple prescriptions can be prescribed in the ED

It has little systemic absorption and is generally very safe and effective.

References

Wells BA, De EJB, Visingardi J, Feustel PJ. IP15-36 IMPACT OF VAGINAL ESTROGEN ON SERIOUS ADVERSE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY. Journal of Urology [Internet]. 2025 May 1;213(5S):e778. Available from: https://doi.org/10.1097/01.JU.0001109984.67114.74.36
Ackerman AL, Bradley M, D'Anci KE, Hickling D, Kim SK, Kirkby E. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). J Urol. 0(0). doi: 10.1097/JU.0000000000004723
Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589
Meister MR, Wang C, Lowder JL, Mysorekar IU. Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e39-e44. doi: 10.1097/SPV.0000000000000790. PMID: 31725016; PMCID: PMC7737516.
Nazarko L. Recurrent lower urinary tract infection in older women [Internet]. Urology & Continence Care Today. Available from: https://www.ucc-today.com/journals/issue/launch-edition/article/recurrent-lower-urinary-tract-infection-in-older-women-ucct

Summarized by Aaryn David & Ahmed Abdel-Hafiz | Edited by Aaryn David & Ahmed Abdel-Hafiz, NREMT-P

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Podcast 1008: Acupuncture for Low Back Pain in Older Adults Jun 01, 2026

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Back pain is a common presenting complaint in the emergency department.
Challenges arise when tailoring care to elderly populations using standard medical therapy:

Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion.
Pain medications such as opiates have side effects including constipation, respiratory depression, and hypotension.
NSAIDs carry a risk of GI bleeding and worsening kidney function with chronic use.

A randomized clinical trial assessing the effects of acupuncture on low back pain took 800 adults aged 65 and older with chronic low back pain and placed them into one of three treatment arms:

Usual medical care
Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus usual medical care
Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus 4-6 maintenance sessions during the next 12 weeks, plus usual medical care

Using the Roland-Morris Disability Questionnaire (RMDQ) score, they assessed disability at 6 months and 12 months.

The study found that those who had undergone treatment with acupuncture had significantly greater improvements in disability related to low back pain compared to the group that was only treated with usual medical care.

Acupuncture is not used in the ER, but could represent a relatively safe adjunctive therapy for patients who are not responding to standard medical therapy alone.

References:

American College of Surgeons Committee on Trauma. Best practices guidelines: geriatric trauma management. American College of Surgeons; 2023. Accessed May 27, 2026. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf
DeBar LL, Wellman RD, Justice M, et al. Acupuncture for chronic low back pain in older adults: a randomized clinical trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348

Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

Podcast 1007: Caffeine Pharmacology May 25, 2026

Show notes

Contributor: Travis Barlock, MD

Educational Pearls:

Caffeine Geography and Types:

Caffeine is found throughout the world and has evolved independently in various plants that are not evolutionarily related through direct lineage, but rather demonstrate convergent evolution (i.e. different species evolve the same traits).
These plants use caffeine as an insecticide.
Examples of caffeine sources include coffee, tea, yerba-mate, guaraná, cacao, and yaupon holly.
Roughly 85% of Americans are estimated to consume caffeine daily.

Caffeine Pharmacology in Humans:

In humans, caffeine is a nonselective competitive antagonist (blocker) of adenosine receptors (A1 and A2A).
During waking hours, neuronal metabolic activity consumes ATP, and a byproduct of ATP hydrolysis is created: adenosine.
Adenosine proceeds to build a "sleep pressure".

Acting on A1 and A2A adenosine receptors to induce sleep (on A1, it suppresses neuronal "wakefulness" and on A2A it is believed to be an inducer of sleep).

Caffeine, by blocking those receptors, blunts sleep induction and feelings of being tired.
Caffeine has a half-life of around 6 hours, and a quarter life of approximately 12 hours, which is when the caffeine will off-load and adenosine can once again occupy those receptors, potentially causing a "crash".
Thus, for shift-workers, it is important to time caffeine intake roughly 10 hours before target bed time.
Caffeine exerts other effects on the body.

It is methylxanthine similar to theophylline, which works as a bronchodilator (via phosphodiesterase and adenosine pathways). Caffeine has clinical use to promote bronchodilation in pre-term infants.
Caffeine exerts diuretic effects as well (blocking proximal renal tubule reabsorption).
Recent ingestion of caffeine may blunt therapeutic use of adenosine in patients with SVT.

Key Takeaway?

Caffeine exerts a wide variety of effects beyond making us feel more awake. It has cardiovascular, pulmonary, and renal implications in its pharmacodynamics.

References

Benarroch EE. Adenosine and its receptors: multiple modulatory functions and potential therapeutic targets for neurologic disease. Neurology. 2008;70(3):231-236. doi:10.1212/01.wnl.0000297939.18236.ec
Mitchell DC, Knight CA, Hockenberry J, Teplansky R, Hartman TJ. Beverage caffeine intakes in the U.S. Food Chem Toxicol. 2014;63:136-142. doi:10.1016/j.fct.2013.10.042
Bruschettini M, Brattström P, Russo C, Onland W, Davis PG, Soll R. Caffeine dosing regimens in preterm infants with or at risk for apnea of prematurity - Bruschettini, M - 2023 | Cochrane Library. Accessed May 23, 2026. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013873.pub2/full?cookiesEnabled
Huang R, O'Donnell AJ, Barboline JJ, Barkman TJ. Convergent evolution of caffeine in plants by co-option of exapted ancestral enzymes. Proc Natl Acad Sci U S A. 2016;113(38):10613-10618. doi:10.1073/pnas.1602575113
Cabalag MS, Taylor DM, Knott JC, Buntine P, Smit D, Meyer A. Recent caffeine ingestion reduces adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia. Acad Emerg Med. 2010;17(1):44-49. doi:10.1111/j.1553-2712.2009.00616.x

Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P

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Podcast 1006: Cannabinoid Pharmacology May 18, 2026

Show notes

Contributor: Travis Barlock, MD

Educational Pearls:

Endocannabinoid System: THC binds CB1 and CB2 receptors in neurons and immune cells

Δ9-Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis
CB1 and CB2 receptors typically bind endogenously-produced 2-arachidonoylglycerol (2-AG) and anandamide (AEA) to regulate pain, stress, and inflammation
THC similarly binds CB1 and CB2, leading to the cannabinoid high: euphoria, paranoia, anxiety, analgesia, anti-inflammation, and appetite, among a variety of others
Ingestion via edibles, vice inhalation via smoking, leads to chemical modification of Δ9-THC to 11-hydroxy-Δ9-THC, which more easily crosses the blood-brain barrier and binds CB1 with higher affinity, leading to increased psychoactivity

Cannabinoid Hyperemesis Syndrome (CHS): Chronic THC use leading to the classic presentation of persistent nausea and intense, frequent vomiting

Chronic activation of CB1 receptors in brain builds a tolerance and dependence on THC, in addition to chronic activation of the capsaicin and vanilloid receptor TRPV1, which binds capsaicin or is activated by heat
Treatment by warm showers works due to TRPV1 activation by heat
Treated with benzodiazepines, fluids, and gastro-intestinal or central nervous system agents according to patient presentation

Over 200 synthetic cannabinoids have been created (K2, spice, black mamba, mojo, etc), which are more dangerous and can lead to a variety of etiologies

Acetaminophen binds CB1 receptors to reduce inflammatory pain

References

Loganathan P, Gajendran M, Goyal H. A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome. Pharmaceuticals (Basel). 2024;17(11):1549. Published 2024 Nov 18. doi:10.3390/ph17111549
Wall ME, Sadler BM, Brine D, Taylor H, Perez-Reyes M. Metabolism, disposition, and kinetics of delta-9-tetrahydrocannabinol in men and women. Clin Pharmacol Ther. 1983 Sep;34(3):352-63. doi: 10.1038/clpt.1983.179. PMID: 6309462.
Mills B, Yepes A, Nugent K. Synthetic Cannabinoids. Am J Med Sci. 2015 Jul;350(1):59-62. doi: 10.1097/MAJ.0000000000000466. PMID: 26132518.
Klinger-Gratz PP, Ralvenius WT, Neumann E, et al. Acetaminophen Relieves Inflammatory Pain through CB1 Cannabinoid Receptors in the Rostral Ventromedial Medulla. J Neurosci. 2018;38(2):322-334. doi:10.1523/JNEUROSCI.1945-17.2017

Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P

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