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 761: Peritonsillar Abscess: To Stab or Not to Stab? Mar 07, 2022

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Often present with complaints of sore throat, pain with swallowing, difficulty swallowing, voice change, and possible fever
Retrospective study from 2018 evaluated outcomes of peritonsillar abscess with two management arms, surgical vs. non-surgical treatment
Non-surgical treatment only included IV fluids as well as IV ceftriaxone + clindamycin; Surgical treatment included either needle aspiration or incision and drainage of the abscess as well as the medical treatment from the non-surgical arm
Failure rate in both arms were statistically equivalent, but patients in the surgical arm had more days missed from work and more use of opioid medications for pain

References

Battaglia A, Burchette R, Hussman J, Silver MA, Martin P, Bernstein P. Comparison of Medical Therapy Alone to Medical Therapy with Surgical Treatment of Peritonsillar Abscess. Otolaryngol Head Neck Surg. 2018;158(2):280-286. doi:10.1177/0194599817739277

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!

Podcast 760: Why Fentanyl is the Worst Mar 01, 2022

Show notes

Contributor: Don Stader, MD

Educational Pearls:

Fentanyl's common administration route through pills has lowered the psychological barrier of using opioid compared to injecting and smoking heroin
Fentanyl is showing up in all illicit drugs with documented cases even in marijuana
Testing for fentanyl is difficult and requires a send out test because UA does not show up not common in ED but can better inform our care
Fentanyl doesn't show up on UA drug screen and requires a send out test, thus we should ask patients if they're using fentanyl specifically
Send any patient using an illicit drug home with Narcan to protect them from potential opioid overdoses
Start patients on buprenorphine for opioid withdrawal in the ED
Fentanyl is very lipophilic, thus patients require longer washout times (sometimes over 24 hours) before buprenorphine induction to avoid precipitated withdrawal

References:

Adams, K.K., Machnicz, M. & Sobieraj, D.M. Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review. Addict Sci Clin Pract 16, 36 (2021). https://doi.org/10.1186/s13722-021-00244-8

Moustaqim-Barrette, A., Dhillon, D., Ng, J. et al. Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review. BMC Public Health 21, 597 (2021). https://doi.org/10.1186/s12889-021-10497-2

*Image from NIDA

Summarized by Mason Tuttle

Podcast 759: Hyperkalemia and Myth of Kayexalate Feb 28, 2022

Show notes

Contributor: Nick Tsipis, MD

Educational Pearls:

Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples
Hyperkalemia is commonly associated with end stage renal disease, acute kidney injury or acute renal failure
Cardiac dysrhythmias are the primary concern with hyperkalemia, common EKG changes (and approximate serum levels) can include:
- Peaked T waves that start to show at serum K of 6
- Second sign is lengthening of PR and QRS intervals due to extended repolarization
- Severe hyperkalemia manifests as a sine wave around serum of 8-9

Three approaches to treat hyperkalemia:
- Stabilize cardiac membrane with calcium
- Shift potassium back into the cell, insulin and albuterol are common agents used.
- Potassium binding for excretion
Cochrane review showed no significant effects of Kayexalate on serum K in 4 hours
Bowel necrosis is a rare adverse event that can occur with Kayexalate
More myths and misconceptions about hyperkalemia addressed in reference below!

References:

Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022;52:85-91. doi:10.1016/j.ajem.2021.11.030

Mahoney BA, Smith WA, Lo DS, Tsoi K, Tonelli M, Clase CM. Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev. 2005;2005(2):CD003235. Published 2005 Apr 18. doi:10.1002/14651858.CD003235.pub2

Li T, Vijayan A. Insulin for the treatment of hyperkalemia: a double-edged sword?. Clin Kidney J. 2014;7(3):239-241. doi:10.1093/ckj/sfu049

Summarized by Mason Tuttle| Edited by Nick Tsipis, MD

Mental Health Monthly #10: The Elderly Psychotic Patient Feb 23, 2022

Show notes

Dr. Kim Nordstrom, a practicing emergency psychiatrist and associate professor with the University of Colorado, discusses various work-up models alongside valuable bedside tools for elderly patients with acute psychosis. In this podcast, she explores the methods to differentiate primary psychiatric psychosis from medically mediated psychosis in the elderly using an empirical bedside tool. Furthermore, Dr. Nordstrom educates our listeners on the treatment modalities available and currently recommended for new psychosis in the elderly.

Key Points:

Non-psychiatric causes of psychosis include lobar degeneration, sensory deficits, pharmacologic mediators, and others.
ADEPT tool, developed by CPE under an ACEP sponsorship, is a useful guideline for rapid and reliable assessment of psychosis in the elderly.
DTS (delirium triage screen) tool, embedded in the ADEPT, is 98% sensitive to rule-out delirium.
BCAM (brief concussion assessment method) is used if DTS is positive to rule-in delirium with high specificity.

ADEPT Tool: https://www.acep.org/patient-care/adept

DTS Tool: http://eddelirium.org/delirium-assessment/dts-calculator/

BCAM Tool: http://eddelirium.org/delirium-assessment/bcam-calculator/

Source: Shenvi C, Kennedy M, et al. Managing delirium and agitation in the older emergency department patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb; 75(2): 136–145.

Podcast 758: Vaccine Safety During Pregnancy Feb 22, 2022

Show notes

Contributor: Nick Tsipis, MD

Educational Pearls:

Observational study in Israel evaluated cohort of vaccinated pregnant women receiving the initial Pfizer-BioNTech COVID-19 mRNA vaccine
Looked at 24,288 newborns with about 16,697 exposed to maternal vaccination in utero
Longitudinal follow up showed no significant difference in preterm births, neonatal hospitalizations, post-natal hospitalizations, congenital abnormalities, or mortality
While this is not a randomized-controlled trial, this observational trial has a very large population that was studied supporting the safety profile of birth outcomes relating to receiving COVID mRNA vaccines during pregnancy

References

Goldshtein I, Steinberg DM, Kuint J, et al. Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Neonatal and Early Infant Outcomes [published online ahead of print, 2022 Feb 10]. JAMA Pediatr. 2022;e220001. doi:10.1001/jamapediatrics.2022.0001

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

Donate to EMM today!

Podcast 757: History of Fevers and Thermometers Feb 21, 2022

Show notes

Contributor: Chris Holmes, MD

Educational Pearls:

Dr. Carl Reinhold August Wunderlich, of the mid-1800s, was the first physician to suggest temperature was related to disease processes and his measurements set the 37˚C (98.6˚F) as the baseline temperature
Thermometers were adapted to be sold to the public with guidelines for temperature measurement interpretation
Taller and thinner individuals, anyone taking a temperature in the morning, and the elderly have decreased temperatures
Temperature averages have been decreased and the actual average temperature appears to be closer to 97.5˚ currently

References

Wright WF. Early evolution of the thermometer and application to clinical medicine. J Therm Biol. 2016;56:18-30. doi:10.1016/j.jtherbio.2015.12.003

Geneva II, Cuzzo B, Fazili T, Javaid W. Normal Body Temperature: A Systematic Review. Open Forum Infect Dis. 2019;6(4):ofz032. Published 2019 Apr 9. doi:10.1093/ofid/ofz032

Chen W. Thermometry and interpretation of body temperature [published correction appears in Biomed Eng Lett. 2019 Feb 25;9(1):19]. Biomed Eng Lett. 2019;9(1):3-17. Published 2019 Feb 9. doi:10.1007/s13534-019-00102-2

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

Podcast 756: Violence Towards ED Staff Feb 15, 2022

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

ACEP survey was done in 2018 looking at violence towards staff in the ED with only 10% of those solicited responding
Survey found 47% of respondents were assaulted and 71% had witnessed violence towards staff
Regarding what was done about the violence, 28% said patients were flagged by the hospital, 21% said patient was arrested by police/hospital security, 6% of the cases resulted in the hospital pressing charges, and in 3% of cases the staff were advised to press charges
Analyzing the type of violence that occurred, it was found that in 44% of the incidents staff were hit/slapped, 30% were spit on, 28% were punched, 27% were kicked, 17% were scratched, 6% were bitten, 2% were assaulted with a weapon, and 1% were sexually assaulted
ED violence is a very serious matter and you can learn more about the survey and initiatives at the links below

References

https://www.acep.org/administration/violence-in-the-emergency-department-resources-for-a-safer-workplace/

https://www.emergencyphysicians.org/press-releases/2018/10-2-2018-violence-in-emergency-departments-is--increasing-harming-patients-new-research-finds

https://stopedviolence.org/

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

Donate to EMM today!

Podcast 755: Tubo-Ovarian Abscess Feb 14, 2022

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Tubo-ovarian abscess is a rare complication of pelvic inflammatory disease
Usually presents with chief complaint of abdominal pain and is often diagnosed by CT of the abdomen/pelvis
Hospitalization is indicated 60-80% of patients improve with an IV anaerobic cephalosporin (cefoxitin or cefotetan) with doxycycline or using clindamycin and gentamicin
Mortality can occur in up to 5% of patients, often as a result of progression to septic shock

References

Kairys N, Roepke C. Tubo-Ovarian Abscess. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448125/

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

Podcast 754: Balanced Fluids vs. Normal Saline, The Battle Continues Feb 08, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Normal saline is thought to interfere with renal function and cause an acidosis and balanced fluids (like lactated ringers) are a better option
The SALT-ED trial and SMART trial showed a small benefit with renal injury and need for dialysis using balanced fluid in critically ill patients
Recent multicenter RCT in Brazil evaluated balanced fluids versus normal saline and looked at 90-day mortality
Found no difference in 90-day mortality or secondary outcomes like renal function
PLUS trial is currently being done in Australia and New Zealand to further evaluate fluid choice
Larger trials don't show a major difference at this point, keep an eye out for future trials

References

Semler MW, Wanderer JP, Ehrenfeld JM, et al. Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial. Am J Respir Crit Care Med. 2017;195(10):1362-1372. doi:10.1164/rccm.201607-1345OC

Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584

Zampieri FG, Machado FR, Biondi RS, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial [published online ahead of print, 2021 Aug 10]. JAMA. 2021;326(9):1-12. doi:10.1001/jama.2021.11684

https://clinicaltrials.gov/ct2/show/NCT02721654

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

Donate to EMM today!

Podcast 753: Ring Cutting Raptors Feb 07, 2022

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Techniques regarding ring removal in the ED were evaluated in a recent study which looked at using trauma shears versus the motorized ring cutters
A certain type of trauma shear has a ring-cutter attached to it, 7 seconds to remove vs. about 70 seconds for motorized ring cutters
Both the users of the devices and the patients preferred the ring-cutter shears

References

Walter J, DeBoer M, Koops J, Hamel LL, Rupp PE, Westgard BC. Quick cuts: A comparative study of two tools for ring tourniquet removal. Am J Emerg Med. 2021;46:238-240. doi:10.1016/j.ajem.2020.07.039

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

Donate to EMM today!

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected