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 777: Grass, Weed, and Ancient Rome May 02, 2022

Show notes

Contributor: Chris Holmes, MD

Educational Pearls:

Antiemetics were used in ancient Rome to help with sea-sickness and included toxic substances such as wine and wormwood and white hellborn
The first antihistamine used for nausea, dramamine, was introduced in 1947 for motion sickness
After this chlorpromazine, prochlorperazine, and promethazine came about in the 1950s and 1960s
Cannabis, colloquially referred to as weed, isolates like THC used in the 1970s to help with chemotherapy-induced
After this in the 1980s, ondansetron and metoclopramide were introduced for more severe chemotherapy-induced nausea
Lastly, NK-1 inhibitors were introduced to treat nausea

References

Sanger GJ, Andrews PLR. A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research. Front Pharmacol. 2018;9:913. Published 2018 Sep 4. doi:10.3389/fphar.2018.00913

Summarized by John Spartz, MS4 | Edited by 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!

Mental Health Monthly #12: Management of Opioid Use Disorder with MAT (Medication-Assisted Treatment) Apr 27, 2022

Show notes

In this special episode of MHM, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the implications of OUD in Colorado. As a substance use disorder specialist, Dr. Haddad provides an invaluable perspective on various treatment modalities for OUD in the outpatient and inpatient settings. Finally, Dr. Haddad and Dr. Dhaliwal discuss the implications of the newly introduced Colorado legislation affecting patients with OUD and their providers.

Key Points:

The classic Suboxone therapy for heroin or prescription opioid detox can precipitate severe withdrawal in street fentanyl users.
The three FDA-approved MATs include methadone (full opioid agonist), buprenorphine (partial opioid agonist), and naltrexone (opioid antagonist).
Street fentanyl does not behave like pharmaceutical-grade fentanyl; a recent study found that the chemical composition of a street pill varied and included opioid analogs and benzodiazepines
Fentanyl attaches and detaches to/from the receptor more easily and quickly than buprenorphine. Dr. Haddad suspects that as fentanyl weans from the patient's system, there is not enough to compete with Suboxone, therefore precipitating withdrawal.
Suboxone vs. naltrexone: Suboxone can be started sooner to treat post-acute withdrawal. Naltrexone helps to prevent relapse but may slow a patient's emotional return to baseline.
Dr. Haddad recently developed a new home induction program to provide patients with supportive measures for the withdrawal period, which include pharmacologic interventions like clonidine, trazodone, dicyclomine, or loperamide.
Resources after discharge in Colorado include mental health centers, Front Range Clinic, Magnolia Mental Health
The criminalization of substance use disorders moves people from treatment-focused settings to punitive settings and leads to prison population expansion without adequate mental healthcare resources.

Podcast 776: Single-Site Blood Cultures Apr 26, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Traditionally, blood cultures are drawn from two separate sites despite no data to suggest this is better than drawing blood from one site
Recent study evaluated multi-site versus single-site blood cultures to determine if there was a difference in accuracy or contamination
Positive yield was 20% in the single-site year and 17% in the multi-site year
No difference in contamination between the two groups

References

Ekwall-Larson A, Yu D, Dinnétz P, Nordqvist H, Özenci V. Single-Site Sampling versus Multisite Sampling for Blood Cultures: a Retrospective Clinical Study. J Clin Microbiol. 2022;60(2):e0193521. doi:10.1128/JCM.01935-21

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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Podcast 775: Olecranon Bursitis Apr 25, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Olecranon bursitis refers to inflammation in the bursa of the elbow and can be due to infection or trauma
Recent study examined treating suspected septic olecranon bursitis with antibiotics versus drainage
About 90% of the patients treated with antibiotic therapy for this issue did not require subsequent drainage or hospitalization for intravenous antibiotics
Consider treating suspected olecranon bursitis with antibiotic therapy and good return precautions rather than defaulting to drainage

References

Beyde A, Thomas AL, Colbenson KM, et al. Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. Acad Emerg Med. 2022;29(1):6-14. doi:10.1111/acem.14406

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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On the Streets #13: Pre-hospital Cardiology Concepts Apr 20, 2022

Show notes

On this episode of On the Streets, our host, Jordan Ourada, talks with cardiologist, Dr. Chirag Chauhan, about all things cardiac. Highlighted topics:

Wrist versus femoral access in the cath lab
The most important prehospital interventions for an MI
Nitroglycerin: Who gets it and what are the precautions
Lidocaine and amiodarone in a heart attack
CPR assist devices

Podcast 774: Maggots Apr 19, 2022

Show notes

Contributor: Chris Holmes, MD

Educational Pearls:

Maggots were discovered as a therapy to help wound healing in WWI, but this fell out of favor after the discovery of penicillin
One study from Israel used maggots in treating diabetic foot wound with positive results but notable patient discomfort
Maggots debride tissue, kill MRSA, promote angiogenesis, and promote fibroblast migration to lay down new tissue
While maggots may be very useful in wound healing, the reality of the therapy may make patients very uncomfortable

References

Gilead L, Mumcuoglu KY, Ingber A. The use of maggot debridement therapy in the treatment of chronic wounds in hospitalised and ambulatory patients. J Wound Care. 2012 Feb;21(2):78, 80, 82-85. doi: 10.12968/jowc.2012.21.2.78. PMID: 22584527.

Mohd Zubir MZ, Holloway S, Mohd Noor N. Maggot Therapy in Wound Healing: A Systematic Review. Int J Environ Res Public Health. 2020;17(17):6103. Published 2020 Aug 21. doi:10.3390/ijerph17176103

McCaughan, Dorothy et al. "Patients' perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in-depth qualitative study." Health expectations : an international journal of public participation in health care and health policy vol. 18,4 (2015): 527-41. doi:10.1111/hex.12053

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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Podcast 773: Atrial Fibrillation Medications Apr 18, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Atrial fibrillation is an irregular heart rhythm that sometimes requires rate control in setting of rapid ventricular response (RVR)
Calcium channel blocker and beta blockers are the most frequently used medications to block the AV node and slow down the heart rate in atrial fibrillation with RVR
If a patient is on one of these agents at home, the IV form should be used first
Recent systematic review and meta-analysis found 3 trials addressing which medication to use to control heart rate in atrial fibrillation with RVR with a total of 150 patients
Found diltiazem, a CCB, was 4x more likely to reduce heart rate than metoprolol
50% of patients had a normal heart rate at 21 minutes with diltiazem versus 22% in those who received metoprolol
Both agents had a similar decrease in blood pressure after administration

References

Jafri SH, Xu J, Warsi I, Cerecedo-Lopez CD. Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis. Am J Emerg Med. 2021 Oct;48:323-327. doi: 10.1016/j.ajem.2021.06.053. Epub 2021 Jun 30. PMID: 34274577.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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Podcast 772: Firearms in Suicidal Ideation Apr 12, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Firearms are a dangerous potential method of committing suicide
Death occurs in about 5-15% of suicide attempts overall, but death in suicide attempts using firearms occurs in 85-90% of cases
In some states, families can petition a judge to remove firearms from a house although healthcare providers cannot do this

References

Sarai SK, Abaid B, Lippmann S. Guns and Suicide: Are They Related? Prim Care Companion CNS Disord. 2017 Dec 21;19(6):17br02116. doi: 10.4088/PCC.17br02116. PMID: 29272571.

Anestis MD, Bandel SL, Butterworth SE, Bond AE, Daruwala SE, Bryan CJ. Suicide risk and firearm ownership and storage behavior in a large military sample. Psychiatry Res. 2020 Sep;291:113277. doi: 10.1016/j.psychres.2020.113277. Epub 2020 Jul 2. PMID: 32886959.

Mann JJ, Michel CA. Prevention of Firearm Suicide in the United States: What Works and What Is Possible. Am J Psychiatry. 2016 Oct 1;173(10):969-979. doi: 10.1176/appi.ajp.2016.16010069. Epub 2016 Jul 22. PMID: 27444796.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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Podcast 771: Intubation in Cardiac Arrest Apr 11, 2022

Show notes

Contributor: Don Stader, MD

Educational Pearls:

In a secondary analysis of the PART trial, the mortality effect of timing of airway management for patients in cardiac arrest was examined
Study looked at whether timing played a part in both laryngeal tube placement or endotracheal intubation during cardiac arrest
Did not find any association of timing and survival to hospital discharge
High-quality CPR and defibrillation are the only two things that improve outcomes in cardiac arrest

References

Okubo M, Komukai S, Izawa J, Aufderheide TP, Benoit JL, Carlson JN, Daya MR, Hansen M, Idris AH, Le N, Lupton JR, Nichol G, Wang HE, Callaway CW. Association of Advanced Airway Insertion Timing and Outcomes After Out-of-Hospital Cardiac Arrest. Ann Emerg Med. 2022 Feb;79(2):118-131. doi: 10.1016/j.annemergmed.2021.07.114. Epub 2021 Sep 16. PMID: 34538500.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

Donate to EMM today!

Podcast 770: Xylazine Apr 05, 2022

Show notes

Contributor: Don Stader, MD

Educational Pearls:

Xylazine, referred to as tranq dope colloquially, is an FDA approved animal tranquilizer that is circulating in the illicit drug markets of the northeastern United states
It is a powerful alpha-2 agonist, similar to clonidine, and patients with xylazine overdose may present similarly to opioid overdose
Naloxone will not reverse the effects of xylazine and management is supportive care
Withdrawal symptoms from xylazine use can be treated with clonidine

References

https://www.acep.org/tacticalem/newsroom/oct-2021/xylazine-an-emerging-adulterant/

Nunez J, DeJoseph ME, Gill JR. Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths. Am J Forensic Med Pathol. 2021 Mar 1;42(1):9-11. doi: 10.1097/PAF.0000000000000622. PMID: 33031124.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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