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 743: Rust Rings Jan 03, 2022

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

A rust ring can occur after a metallic foreign body is left in the eye for a prolonged period of time
Issues occur when the rust ring is left as it can epithelialize and become a permanent spot in the patient's vision
An eye burr or Alger brush can help to gouge out the rust ring in the emergency setting
These tools have a failsafe mechanism to prevent the eye burr from going through layers past the cornea (though this does not work if the foreign body is already through the cornea)
Referral to ophthalmology, antibiotic drops, and dilating drops are recommended options upon discharge
Complications include poor wound healing, scarring, and infection

References

Camodeca AJ, Anderson EP. Corneal Foreign Body. [Updated 2021 Apr 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536977/

https://www.reviewofoptometry.com/article/no-insult-to-injury-managing-foreign--body-removal

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 742: Pulse Check During CPR Dec 29, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Pulse checks are necessary during CPR to check for return of spontaneous circulation (ROSC)
Previous studies have shown that assessing ROSC with palpating for pulse are not a very consistent
Study compared palpating pulses at carotid/femoral artery versus a newly contrived gold standard for pulse checks
The gold standard used was an increase in end tidal CO2 + cardiac activity on ultrasound + perfusing rhythm on ECG
Carotid artery palpation was the best location to confirm pulse during pulse check, although femoral artery palpation
- Carotid artery palpation was 92% accurate versus 82% accuracy with femoral pulse check
Regardless of chosen site, remember 10 seconds is the maximum amount of time for a pulse check before resuming CPR

References

Yılmaz G, Bol O. Comparison of femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation: A prospective observational study. Resuscitation. 2021;162:56-62. doi:10.1016/j.resuscitation.2021.01.042

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

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Podcast 741: Calcium for Cardiac Arrest Dec 28, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Study of nearly 400 patients evaluating giving calcium during cardiac arrest with the endpoint as return of spontaneous circulation (ROSC)
Compared giving 1 amp calcium chloride with each round of epinephrine for the first two rounds of epinephrine versus saline placebo
ROSC occurred in 19% of patients in the calcium groups versus 27% in saline placebo group
No magic drugs in cardiac arrest, good CPR and early defibrillation are still the most important factors for ROSC in cardiac arrest

References

Vallentin MF, Granfeldt A, Meilandt C, et al. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021;326(22):2268-2276. doi:10.1001/jama.2021.20929

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

Donate to EMM today!

Podcast 740: Placenta Previa Dec 21, 2021

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

High concern causes of third trimester vaginal bleeding include placenta previa, placental abruption, or vasa previa
In placenta previa, the placenta implants over the cervix and this condition
- Often noted during routine prenatal care on transabdominal ultrasound
Patients present with painful vaginal bleeding, usually in the absence of trauma
Avoid pelvic exam, transvaginal ultrasound, or digital vaginal exam in placenta previa
Risk factors for placenta previa include multiple gestations, previous medical abortions, advanced maternal age, and previous placenta previa
Management usually includes admission to the hospital
- >37 weeks: admission for c-section
- 34-37 weeks: judgment call based on maternal/fetal stability
- <34 weeks: steroids for fetal lung maturation and delay delivery

References

Anderson-Bagga FM, Sze A. Placenta Previa. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539818/

Young JS, White LM. Vaginal Bleeding in Late Pregnancy. Emerg Med Clin North Am. 2019;37(2):251-264. doi:10.1016/j.emc.2019.01.006

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

*Image from BruceBlaus via Wikimedia Commons licensed under Creative Commons license

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Podcast 739: Perceptions of Dress Dec 20, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Study examined patient perceptions of providers wearing traditional white coats, fleece coats and soft-shell jackets
Found that white coats were seen as more professional than other types of dress
Also found that female physicians were viewed as less professional than their male counterparts regardless of dress
Older respondents thought more of white coats than younger respondents
Patient perspective should be considered and reiterating roles may help build relationships with patients

References

Xun H, Chen J, Sun AH, Jenny HE, Liang F, Steinberg JP. Public Perceptions of Physician Attire and Professionalism in the US. JAMA Netw Open. 2021;4(7):e2117779. Published 2021 Jul 1. doi:10.1001/jamanetworkopen.2021.17779

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

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Podcast 738: Acute Mesenteric Ischemia Dec 14, 2021

Show notes

Contributor: Ian Gillman, PA-C

Educational Pearls:

Acute mesenteric ischemia is a condition where bowel loses blood supply from an acute occlusion of the mesenteric arteries
A frequent sign is abdominal pain that is out of proportion to the exam
Atrial fibrillation is one risk factor for mesenteric ischemia
Treatment includes anticoagulation and possible surgical intervention depending on the extent of the ischemia

References

Monita MM, Gonzalez L. Acute Mesenteric Ischemia. [Updated 2021 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

Kühn F, Schiergens TS, Klar E. Acute Mesenteric Ischemia. Visc Med. 2020;36(4):256-262. doi:10.1159/000508739

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

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Podcast 737: TBI Outcomes Dec 13, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Study evaluating patient outcomes after traumatic brain injury (TBI) over 1 year
Trial followed patients with severe TBI (GCS 3-8) and moderate TBI (GCS 9-12)
At 1 year out ½ of the severe TBI group were able to be independent for at least 8 hours per day; ⅔ were independent to this level at one year in the moderate TBI group
¼ of the patient who were in a vegetative state 2 weeks after the traumatic brain injury had good outcomes at 1 year

References

McCrea MA, Giacino JT, Barber J, et al. Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study. JAMA Neurol. 2021;78(8):982-992. doi:10.1001/jamaneurol.2021.2043

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

Donate to EMM today!

Podcast 736: Seasonal Affective Disorder Dec 07, 2021

Show notes

Contributor: Adam Barkin, MD

Educational Pearls:

Seasonal Affective Disorder (SAD) a form of seasonal depression which can result in trouble sleeping, concentration difficulties, changes in appetite, and decreased mood
SAD is a common condition affecting millions of people in the US
Coupling this with the stresses of COVID, these affects may be compounded
To reduce the effects of SAD:
- Stick to a routine
- Exercise
- Light therapy
- Engage with your community
- Meditation
- Tangible bucket list to set goals for the winter
- Nostalgic activity

References

Melrose S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:178564. doi:10.1155/2015/178564

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

The Emergency Medical Minute offers 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 735: End Tidal CO2 and BiPAP Dec 06, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

End tidal CO2 is accurate to 1-4 mmHg in intubated patient but use with those on positive pressure ventilation like BiPAP is unclear
Study looked at patients on BiPAP for COPD or CHF and found end tidal CO2 measurements were significantly underestimated when compared to VBG levels
End tidal CO2 measurements for those on positive pressure ventilation appears to be inaccurate

References

Uzunay H, Selvi F, Bedel C, Karakoyun OF. Comparison of ETCO2 Value and Blood Gas PCO2 Value of Patients Receiving Non-invasive Mechanical Ventilation Treatment in Emergency Department [published online ahead of print, 2021 Apr 27]. SN Compr Clin Med. 2021;1-5. doi:10.1007/s42399-021-00935-y

Casati A, Gallioli G, Scandroglio M, Passaretta R, Borghi B, Torri G. Accuracy of end-tidal carbon dioxide monitoring using the NBP-75 microstream capnometer. A study in intubated ventilated and spontaneously breathing nonintubated patients. Eur J Anaesthesiol. 2000;17(10):622-626. doi:10.1046/j.1365-2346.2000.00731.x

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

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Diversity and Inclusion Award

Podcast 734: Push Dose Antibiotics Dec 01, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Recent study at a hospital in Chicago with a shortage of normal saline decided to push IV ceftriaxone rather than the typical infusion of the antibiotic
Retrospective chart analysis of about 800 patients to determine safety of giving a push dose of ceftriaxone
Only 1 complication due to the ceftriaxone causing a patient to vomit

References

Agunbiade A, Routsolias JC, Rizvanolli L, Bleifuss W, Sundaresan S, Moskoff J. The effects of ceftriaxone by intravenous push on adverse drug reactions in the emergency department. Am J Emerg Med. 2021;43:245-248. doi:10.1016/j.ajem.2020.03.022

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

Donate to EMM today!

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