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 706: Pepper Spray Decon Aug 18, 2021

Show notes

Contributor: Ramnik Dhaliwal, MD JD

Educational Pearls:

Pepper spray is a highly irritating compound with active ingredient of capsaicin
Techniques to help decontaminate and alleviate symptoms of an exposure include:
- Disrobing the patient to prevent further exposure
- Half milk of magnesia and half water mixture can be used to soothe the skin in the area of exposure
- Proparacaine followed by Morgan lens to irrigate the eye in adults
- Nasal cannula connected to a liter of normal saline can passively irrigate the eye in small children and other less than cooperating patients

References

Tidwell RD, Wills BK. Tear Gas and Pepper Spray Toxicity. [Updated 2020 Nov 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544263/

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

Podcast 705: Pyloric Stenosis Aug 17, 2021

Show notes

Contributor: Neil Cella, MD

Educational Pearls:

Pylorus becomes hypertrophied and does not allow food or liquid to pass through to the duodenum
tOccurs between the ages of 3 weeks to 3 months
Classic presentation includes projectile nonbilious vomiting and palpable abdominal mass
Ultrasound can visualize/diagnose pyloric stenosis and the treatment is surgical correction
Be aware that electrolyte abnormalities and acid/base disturbances may occur

References

Garfield K, Sergent SR. Pyloric Stenosis. [Updated 2021 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555931/

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

Podcast 704: Treatment of Pneumothorax Aug 16, 2021

Show notes

Contributor: Adam Barkin, MD

Educational Pearls:

Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up
316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms
15% of the conservative group required further intervention as determined by prespecified protocols
94.4% of the intervention group had resolution at 8 weeks, whereas 98.5% of the conservative group had resolution at 8 weeks
- These data were affected by poor follow up
CXR resolution average of 16 days in the intervention group and 30 days in the conservative group
Symptom resolution was similar between the two groups (median 15 days vs. 14 days)
Recurrence at 12 months was 17% in interventional group vs 8% in conservative group
41 adverse events in intervention group and 13 adverse events in conservative group

References

Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415. doi:10.1056/NEJMoa1910775

Franzen, D. (2019, November). Pneumothorax. Society of Academic Emergency Medicine. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-respiratory/pneumothorax.

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 #8: Trauma-Informed Care Aug 11, 2021

Show notes

Contributor: Randi Libbon, MD

The Core features of trauma-informed care include:

Patient empowerment, choice and collaboration. This means educating patients and allowing patients to make choices about their care when possible. Collaboration helps to level the power differential between patients and providers through shared decision making.
Safety and sensitivity: Developing health care settings and activities that ensure patients' physical and emotional safety taking into account their diverse backgrounds of gender, sexuality, race, culture, and ethnicity
Trustworthiness and transparency: Creating clear expectations with patients about what proposed treatments entail, who will provide services, and how care will be provided.

Resources:

Reeves E. A synthesis of the literature on trauma-informed care. Issues Ment Health Nurs. 2015;36(9):698-709. doi: 10.3109/01612840.2015.1025319. PMID: 26440873.

Molloy L, Fields L, Trostian B, Kinghorn G. Trauma-informed care for people presenting to the emergency department with mental health issues. Emerg Nurse. 2020 Mar 10;28(2):30-35. doi: 10.7748/en.2020.e1990. Epub 2020 Feb 25. PMID: 32096370.

Key ingredients for Trauma-informed care from SAMHSA

https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

The National Childhood Traumatic Stress Network:

https://www.nctsn.org/trauma-informed-care

The Science of Adverse Childhood Events and Toxic Stress:

https://www.acesaware.org/ace-fundamentals/the-science-of-aces-toxic-stress/

From the Institute for Health Care Improvement:

http://www.ihi.org/communities/blogs/how-trauma-informed-care-can-help-patients-and-clinicians-during-behavioral-health-emergencies

Podcast 703: Fever in Infants Aug 10, 2021

Show notes

Contributor: Neil Cella, MD

Educational Pearls:

- 10% of patients 100.4) have an serious bacterial infection
- Most of these are UTIs, but also consider pneumonia and meningitis
- Requires CXR, LP, labs, and UA to work up cause of fever
29-60 day old well-appearing febrile infant:
- Can discharge without abx if CXR, lumbar puncture, labs and UA without signs of bacterial infection
If UA is positive for UTI a LP is still indicated for febrile infants

References

Hamilton JL, Evans SG, Bakshi M. Management of Fever in Infants and Young Children. Am Fam Physician. 2020;101(12):721-729.

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

Podcast 702: Paralytic Awareness Aug 09, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Known risk factors for being awake and paralyzed in the OR include only receiving IV medications, long-acting paralytics, and no formal monitoring system for being awake
The ED-AWARENESS study, a prospective single-center study found 2.6% of patients with induced paralysis during mechanical ventilation were aware
Rocuronium was a risk factor for developing awareness while paralyzed in this study
Ensure adequate sedation during paralysis for mechanical ventilation in the ED setting, especially when using rocuronium

References

Pappal RD, Roberts BW, Mohr NM, et al. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532-544. doi:10.1016/j.annemergmed.2020.10.012

Pappal RD, Roberts BW, Winkler W, Yaegar LH, Stephens RJ, Fuller BM. Awareness With Paralysis in Mechanically Ventilated Patients in the Emergency Department and ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2021;49(3):e304-e314. doi:10.1097/CCM.0000000000004824

The Emergency Medical Minute offers AMA PRA Category 1 credits™ via online course modules. For more information and to access this content,, visit our website at www.emergencymedicalminute.org/cme-courses/ and create an account.

Donate to EMM today!

Podcast 701: Elevated Blood Pressure Readings Aug 03, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Recent retrospective cohort study looked at elevated BP readings in the ED and correlation to underlying hypertension
Large cohort of over 30,000 patients found that nearly 50% had an elevated blood pressure reading in the ED
Less than 15% of patients with elevated BP readings in the ED were diagnosed with hypertension within 2 years
Only 25% of patients with BP readings >160/100 were diagnosed with hypertension within 2 years
Patients with an elevated blood pressure reading of >160/100 had only a slightly increased risk of stroke, transient ischemic attack, acute coronary syndrome, heart failure, or death in the next 2 years

References

McAlister FA, Youngson E, Rowe BH. Elevated Blood Pressures Are Common in the Emergency Department but Are They Important? A Retrospective Cohort Study of 30,278 Adults. Ann Emerg Med. 2021;77(4):425-432. doi:10.1016/j.annemergmed.2020.11.005

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

Donate to EMM today!

Podcast 700: Analgesics for Acute Musculoskeletal Pain Aug 02, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Recent RCT compared pain relief in patients receiving five medications for acute musculoskeletal pain
- Acetaminophen 1000mg/ibuprofen 400 mg
- Acetaminophen 1000mg/ibuprofen 800 mg
- Acetaminophen 300 mg/codeine 30 mg
- Acetaminophen 300mg/hydrocodone 5mg
- Acetaminophen 325mg/oxycodone 5mg
No significant difference in pain relief at 1 and 2 hours between all of 5 groups

References

Bijur PE, Friedman BW, Irizarry E, Chang AK, Gallagher EJ. A Randomized Trial Comparing the Efficacy of Five Oral Analgesics for Treatment of Acute Musculoskeletal Extremity Pain in the Emergency Department. Ann Emerg Med. 2021;77(3):345-356. doi:10.1016/j.annemergmed.2020.10.004

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 www.emergencymedicalminute.org/cme-courses/ and create an account.

Donate to EMM today!

Podcast 699: Pediatric Fingernail Avulsions Jul 28, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Traditionally, fingernails were replaced after avulsion using sutures
Sometimes artificial material was placed when the fingernail was not available
Recent study evaluated treatment of fingernail avulsions pediatric patients by replacing the nail versus cleaning and putting a non-adhesive dressing
No difference in the aesthetics or patient satisfaction with the new fingernail between the two treatment groups

References

Seiler M, Gerstenberg A, Kalisch M, Kennedy U, Scheer HS, Weber DM. Non-operative treatment versus suture refixation of the nail plate in paediatric fingernail avulsion injuries. J Hand Surg Eur Vol. 2021;46(5):523-529. doi:10.1177/1753193420965390

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

Donate to EMM today!

Podcast 698: Empathy, Burnout, and Patient Satisfaction Jul 27, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Survey of EM physicians to self-report empathy and burnout levels and correlated with patient satisfaction scores
Patient satisfaction was not affected by what the physicians thought about their level of empathy or burnout
Patient satisfaction was affected by the patient's perception of empathetic behavior by the physician

References

Byrd J, Knowles H, Moore S, et al. Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study [published online ahead of print, 2020 Nov 25]. Emerg Med J. 2020;emermed-2019-209393. doi:10.1136/emermed-2019-209393

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 www.emergencymedicalminute.org/cme-courses/ and create an account.

Donate to EMM today!

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