Emergency Medical Minute

View Top 200 Chart

Back to Rankings Page

Health & Fitness
**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 795: Lithium Toxicity Jul 05, 2022

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Lithium remains a commonly used medication for treating bipolar disorder
Lithium toxicity can be acute, acute-on-chronic, or chronic
Measuring blood lithium level

Therapeutic range of lithium is around 1.6-1.8 mEq/L
>2 mEq/L is likely to cause significant toxicity
>4 mEq/L necessitates lifesaving treatment
The lethal dose of lithium is 700 mg/kg
Lithium can have delayed absorption resulting in levels increasing during hospitalization

Symptoms associated with acute lithium toxicity

Gastrointestinal

Nausea, vomiting, abdominal pain

Neurological

Tremor, nystagmus, CNS depression (late finding)

Cardiovascular

Bradycardia, QT prolongation, EKG changes

Treatment for lithium toxicity

ABCs
Get a good history
GI Decontamination:

Whole bowel irrigation if patient ingested extended-release tablets

Dialysis

Most effective treatment for lithium toxicity

References

Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium Poisoning. J Intensive Care Med. 2017;32(4):249-263.

McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721-728.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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.

Donate to EMM today!

Podcast 794: Brain and Pain Jul 04, 2022

Show notes

Contributor: Don Stader, MD

Educational Pearls:

Pain sensation is generated and modified by the brain
Multiple case reports provide evidence that the degree of pain a patient experiences correlates with how severe they perceive their injury/illness to be
Patients who feel safe and reassured about the care they are receiving have less pain
The patient's narrative about their pain is the strongest factor in determining long-term outcomes of their pain
Helping to shape the narrative around the patient's pain is essential in reducing the incidence of chronic pain and increases the likelihood of pain completely resolving

References

Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013;14(7):502-511.

Dimsdale JE, Dantzer R. A biological substrate for somatoform disorders: importance of pathophysiology. Psychosom Med. 2007;69(9):850-854.

Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain Manag. 2015;5(4):297-317.

Marshall PWM, Schabrun S, Knox MF. Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain. PLoS One. 2017;12(7):e0180788.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

Donate to EMM today!

Podcast 793: Postintubation Sedation and Analgesia Jun 27, 2022

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia
The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine

Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for patients with intracranial bleeds
Precedex is a milder sedative used in the ICU because it decreases time to extubation and reduces the risk of complications associated with long term intubation
Ketamine should be used in hypotensive patients because it does not lower blood pressure, and its bronchodilatory effect is beneficial for asthmatic patients

Versed and ativan are the most commonly encountered benzodiazepine sedatives, but they are infrequently used because they increase the risk of delirium and delay extubation

Benzodiazepines are useful for sedation in patients with delirium tremens

For post intubation analgesia, fentanyl is the drug of choice since it has a lower risk of hypotension than is seen in other narcotics
In the emergency department, intubated and sedated patients should initially be sedated to a RASS of -2 while obtaining imaging, but aim for a RASS of -1 after to decrease side effects and promote earlier extubation

References

Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983-2991.

Garner O, Ramey JS, Hanania NA. Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022.

Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015;75(10):1119-1130.

McKeage K, Perry CM. Propofol: a review of its use in intensive care sedation of adults. CNS Drugs. 2003;17(4):235-272.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

Emergency Medical Minute's Palliative screening event is tonight! There is still time to buy tickets to this intimate evening diving into the nuance of pediatric palliative care, purchase tickets on eventbrite!

Podcast 792: Rectal Prolapse Jun 21, 2022

Show notes

Contributor: Jarod Scott, MD

Educational Pearls:

Rectal prolapse is an evagination of the rectal tissue through the anal opening
Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse

These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities

Noninvasive treatment options include increasing fluid and fiber intake to soften stools as well as using padding/taping to reinforce the perineum
Surgery is an option to repair the prolapse so long as the patient is a good surgical candidate
Medical sugar can be used as a desiccant to dry out and shrink the prolapse thus allowing for easier manual replacement

References

Coburn WM, 3rd, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. 1997;30(3):347-349.

2Gachabayov M, Bendl R, Flusberg M, et al. Rectal prolapse and pelvic descent. Curr Probl Surg. 2021;58(9):100952.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD

Donate to EMM today!

Podcast 791: Hyperglycemic Hyperosmolar State Jun 20, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA
Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality
- Unlike in DKA, patients with HHS do not have elevated ketones
Treatment of HHS includes insulin administration along with correcting fluid and electrolyte abnormalities
When treating HHS, it is important to monitor and follow osmolality regularly because over-rapid correction can result in the development of cerebral edema

References

Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017;101(3):587-606.

Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000-2022, MDText.com, Inc.; 2000.

Long B, Willis GC, Lentz S, Koyfman A, Gottlieb M. Diagnosis and Management of the Critically Ill Adult Patient with Hyperglycemic Hyperosmolar State. J Emerg Med. 2021;61(4):365-375.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD

Donate to EMM today!

On the Streets #14: Trauma Activations in the Field Jun 15, 2022

Show notes

The Emergency Medical Minute is excited to announce that we our upcoming event, Palliative. Check out our event page for more information and to buy tickets: Palliative Eventbrite Page

Podcast 790: Opioids vs OTC Pain Meds Jun 14, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

NSAIDs are a potential alternative to opioids for pain management and are associated with decreased rates of adverse effects
A recent study evaluated the effectiveness of ibuprofen and oxycodone for pain management in pediatric patients with isolated, acute-limb fractures

Participants were discharged home with either ibuprofen or oxycodone and followed for six weeks
There was no difference in pain scores between those taking ibuprofen and those taking oxycodone indicating that they had comparable analgesic effects
Those in the ibuprofen group experienced significantly less adverse events compared to those taking oxycodone
The participants in the ibuprofen group showed quicker return to their normal activities and improved quality of life

In pediatric patients with fracture-related pain, ibuprofen is a safer alternative to oxycodone that is equally effective for pain control

References

Ali S, Manaloor R, Johnson DW, et al. An observational cohort study comparing ibuprofen and oxycodone in children with fractures. PLoS One. 2021;16(9):e0257021.

Cooney MF. Pain Management in Children: NSAID Use in the Perioperative and Emergency Department Settings. Paediatr Drugs. 2021;23(4):361-372.

Yin X, Wang X, He C. Comparative efficacy of therapeutics for traumatic musculoskeletal pain in the emergency setting: A network meta-analysis. Am J Emerg Med. 2021;46:424-429.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD

The Emergency Medical Minute is excited to announce that we our upcoming event, Palliative. Check out our event page for more information and to buy tickets: Palliative Eventbrite Page

Donate to EMM today!

Podcast 789: DOAC Jun 13, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis.
Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes.
2 large observational studies evaluated the recurrence of clots and bleeding risk in patients with newly prescribed Eliquis® or Xarelto® for DVT or PE. Both studies found that Eliquis® had superior outcomes.
Further data is required to determine the preferred DOAC. A randomized trial comparing the two DOACs is upcoming with enrollment ending in 2023.

References

Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data. Ann Intern Med. 2022;175(1):20-28. doi:10.7326/M21-0717

Aryal MR, Gosain R, Donato A, et al. Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world. Blood Adv. 2019;3(15):2381-2387. doi:10.1182/bloodadvances.2019000572

Image from:

Bristol-Myers Squibb Company. Eliquis 10 Million Patients and Counting. Sec.gov. https://www.sec.gov/Archives/edgar/data/14272/000114036119003478/s002621x16_425.htm. Accessed June 12, 2022.

Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD

Donate to EMM today!

Mental Health Monthly #13: Substance-Induced Psychosis (Part I) Jun 08, 2022

Show notes

Substance-Induced Psychosis (Part I)

In this first episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the different substances that cause psychosis and their unique presentations in the ED and in the psychiatric world. First, Dr. Haddad establishes a medical definition of psychosis. Then, Dr. Haddad and Dr. Dhaliwal partake in a fruitful discussion, each providing their unique perspective on the drugs that affect our patient populations today.

Key Points:

Psychosis is a cognitive processing disorder, which leads to auditory hallucinations, visual hallucinations, and delusions.
Axis one psychosis like that from schizophrenia or mania typically produces auditory hallucinations, not visual hallucinations. Delusions are also common in underlying psychiatric psychosis.
One of the most common substances that cause psychosis today is methamphetamine. Meth-induced psychosis can mimic schizophrenia symptoms, though tactile hallucinations are very common with methamphetamine use.
Methamphetamine is active for up to about 8 hours but can vary depending on underlying mental health predispositions, which can be exacerbated for several days or a week before neurotransmitters right themselves after meth use.
Cannabis can lead to psychosis and paranoia for people - especially young people - with a predisposition to schizophrenia or bipolar.
Alcohol-related psychosis comes primarily from withdrawal, though acute alcohol intoxication may cause mild alcoholic hallucinosis.
The hallmark of delirium tremens is a fluctuating, waxing-and-waning consciousness, which can occur 72 hours after the last drink. DTs can occur after treatment of the physical withdrawal symptoms.
Alcohol withdrawal can occur even at high BALs relative to a patient's baseline.
Cocaine psychosis is similar to methamphetamine-induced psychosis.

Recorded, Summarized, and Edited By: Jorge Chalit

Podcast 788: Tracheostomy Bleeding Jun 07, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Tracheostomy bleeding is a rare but potentially life-threatening complication that usually occurs within the first month of tracheostomy tube placement
No matter how severe the bleeding, every patient should be evaluated to rule out a tracheo-innominate fistula between the tracheostomy and the innominate artery
If the patient is currently bleeding and has a cuffed tracheostomy tube, over-inflate the balloon to compress the bleeding vessel
Consider replacing an uncuffed tracheostomy tube with a cuffed tube or an ET tube

If the tracheostomy was performed in the last seven days, use a bougie or bronchoscope to replace the uncuffed tube due to increased risk of opening a false track into the subcutaneous tissue

If bleeding cannot be controlled, follow mass-transfusion protocols, and as a last resort, remove the tube and insert a finger into the stoma to manually compress the artery

References

Bontempo LJ, Manning SL. Tracheostomy Emergencies. Emerg Med Clin North Am. 2019;37(1):109-119.

Khanafer A, Hellstern V, Meißner H, et al. Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft. CVIR Endovasc. 2021;4(1):30.

Manning Sara, Bontempo Laura. Complications of Tracheostomies. In: Mattu A and Swadron S, ed. ComPendium. Burbank, CA: CorePendium, LLC. https://www.emrap.org/corependium/chapter/reckOdDn9Ljn7sBLy/Complications-of-Tracheostomies. Updated August 17, 2021. Accessed June 5, 2022.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, MPH & Erik Verzemnieks, MD

Donate to EMM today!

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected