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 687: STI Complications Jun 30, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

PID (pelvic inflammatory disease) occurs when the infection ascends into the uterus
Tubo-ovarian abscess occurs when the infection ascends to the fallopian tubes
Fitz-Hugh-Curtis syndrome occurs when the infection enters the peritoneum and causes peritoneal inflammation with peri-hepatic inflammation
These conditions require GYN consultation and often more robust antibiotic therapy for treatment

References

Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin North Am. 2008;22(4):693-708. doi:10.1016/j.idc.2008.05.008

Basit H, Pop A, Malik A, et al. Fitz-Hugh-Curtis Syndrome. [Updated 2021 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

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

Podcast 686: Vaginal Self Swabs Jun 29, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Recent study evaluated vaginal self swab testing for STIs to determine if they are equally sensitive to provider-obtained swab
515 patients consented to both tests and 95% agreement was found between the two methods of obtaining samples
75% of participants who preferred this over the pelvic exam, although some patients were concerned they did not perform the self swab correctly
Consider vaginal self swab with proper coaching as an option for patients

References

Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis [published online ahead of print, 2021 Jan 18]. Acad Emerg Med. 2021;10.1111/acem.14213. doi:10.1111/acem.14213

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!

Podcast 685: Cultural Sensitivity with LGBTIQ+ Patients Jun 28, 2021

Show notes

Contributor: Dr. Nick Gorton, MD

Educational Pearls:

Use transgender people's correct names and pronouns, the Russell study found a 56% reduction in suicide behavior with chosen name usage
⅕ to ½ of transgender people report they avoided seeking care in the ED because of fear of transphobic treatment
Understanding the definitions of gender identity, gender expression, assigned sex at birth, physical attraction, and emotional attraction are necessary for improving treatment of the LGBTIQ+ community
Explain reasons for asking questions that address physical characteristics and/or sexual attraction
Lastly, if you make a mistake simply correct the mistake, apologize, and immediately move on

References

Transgender Unicorn

TransLine

Treatment Guideline

Silicone pumping handout for patients and providers

https://www.ustranssurvey.org/reports

Pollitt, A. M., Ioverno, S., Russell, S. T., Li, G., & Grossman, A. H. (2019). Predictors and mental health benefits of chosen name use among transgender youth. Youth & society, 0044118X19855898.

Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4), 503-505.

Samuels, E. A., Tape, C., Garber, N., Bowman, S., & Choo, E. K. (2018). "Sometimes you feel like the freak show": a qualitative assessment of emergency care experiences among transgender and gender-nonconforming patients. Annals of emergency medicine, 71(2), 170-182.

Thompson-Blum, D. N., Coleman, T. A., Phillips, N. E., Richardson, S., Travers, R., Coulombe, S., ... & Davis, C. (2021). Experiences of Transgender Participants in Emergency Departments: Findings from the OutLook Study. Transgender Health.

Bauer, G. R., Scheim, A. I., Deutsch, M. B., & Massarella, C. (2014). Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Annals of emergency medicine, 63(6), 713-720.

*Ongoing LGBTQIA+ topics are identified through collaborations with local Denver organization the Queer Umbrella as part of a new longitudinal effort to raise awareness of health disparities affecting the LGBTQIA+ community.

Stay tuned as we continue to provide educational content to support this community and uplift LGBTQIA+ health providers and their practices all year long.

Podcast 684: Acidosis Jun 23, 2021

Show notes

Contributor: Nick Tsipis, MD

Educational Pearls:

pH 7.45=alkalemia
If pH low and pCO2 high, indicates a respiratory acidosis
If pH low and pCO2 low, indicates metabolic acidosis
After determining type of acidosis, check bicarb to determine compensation for acidosis and check electrolytes to calculate anion gap
Metabolic acidosis can present with tachypnea (Kussmaul breathing) and hypotension due to loss of catecholamine function and suboptimal cardiac function at low pH
Treat with IV fluids and address the underlying cause, limited role for bicarb

References

Burger MK, Schaller DJ. Metabolic Acidosis. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

Cadogan M. Acid Base Disorders. Life in the Fast Lane • LITFL. https://litfl.com/acid-base-disorders/. Published November 3, 2020. Accessed June 23, 2021.

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

Donate to EMM today!

Podcast 683: Zofran vs. Haldol for Cannabinoid Hyperemesis Syndrome Jun 22, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Around 30 patients with cannabinoid hyperemesis syndrome (CHS) randomized treatment in three arms with 8mg Zofran, Haldol 0.05 mg/kg, and Haldol 0.1 mg/kg
Haldol arms performed better on all measures compared to Zofran
Extrapyramidal symptoms were significantly higher in the Haldol group than Zofran, especially the high-dose Haldol group

References

Ruberto AJ, Sivilotti MLA, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Ann Emerg Med. 2021;77(6):613-619. doi:10.1016/j.annemergmed.2020.08.021

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

Donate to EMM today!

Podcast 682: Snake Bites Jun 21, 2021

Show notes

Contributor: Gretchen Hinson, MD

Educational Pearls:

Pit vipers include cottonmouths, rattlesnakes, and copperheads
- All have folding long fangs, triangular face, and elliptical pupils
About 5,000 snakebites per year reported to Poison Control
Initially develop a local reaction (swelling, bruising, pain, bullae)
Complications can include
25% of snake bites result in no envenomation (dry bites)
20% of bites have serious side-effects, which can include hematologic, cardiovascular, neurologic and, muscular abnormalities, or even anaphylaxis to the envenomation itself
Minor symptoms should be observed for 12-24 hours
Moderate to severe symptoms are typically treated with antivenom
CroFab and other antivenoms are expensive, with costs upwards of $3200 per vial wholesale, though newer agents are cheaper
Treat with 4-6 vials of CroFab initially with moderate symptoms and subsequent redosing with

References

Buchanan JT, Thurman J. Crotalidae Envenomation. [Updated 2021 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

Kanaan NC, Ray J, Stewart M, et al. Wilderness Medical Society Practice Guidelines for the Treatment of Pitviper Envenomations in the United States and Canada. Wilderness Environ Med. 2015;26(4):472-487. doi:10.1016/j.wem.2015.05.007

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

Donate to EMM today!

Podcast 681: Internal Hernias Jun 16, 2021

Show notes

Contributor: Adam Barkin, MD

Educational Pearls:

Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions
Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis
Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension
Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery
CT is very >90% sensitivity and specific in diagnosing SBO due to internal hernia
- Mesenteric swirl is a classic radiology finding
Treatment with immediate surgical consultation for possible OR bowel decompression
Start on broad spectrum antibiotics with any signs of sepsis

References

Lanzetta MM, Masserelli A, Addeo G, et al. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Acta Biomed. 2019;90(5-S):20-37. Published 2019 Apr 24. doi:10.23750/abm.v90i5-S.8344

Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-717. doi:10.2214/AJR.05.0644

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

Donate to EMM today!

Podcast 680: Coronary Artery Dissection Jun 15, 2021

Show notes

Contributor: Adam Barkin, MD

Educational Pearls:

Spontaneous coronary artery dissection (SCAD) is the most common cause of acute MI in women under 50 years old
Risk factors include fibromuscular dysplasia, extreme exercise, stress, pregnancy, and recent birth
Diagnosed in cath lab but medically managed and usually do not get a stent
Treated with dual antiplatelet therapy and beta-blockers

References

Yip A, Saw J. Spontaneous coronary artery dissection-A review. Cardiovasc Diagn Ther. 2015;5(1):37-48. doi:10.3978/j.issn.2223-3652.2015.01.08

Janssen EBNJ, de Leeuw PW, Maas AHEM. Spontaneous coronary artery dissections and associated predisposing factors: a narrative review. Neth Heart J. 2019;27(5):246-251. doi:10.1007/s12471-019-1235-4

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

Donate to EMM today!

Podcast 679: Antibiotics for CAP Jun 09, 2021

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Community-acquired pneumonia (CAP) is normally stratified into outpatient-candidates vs. inpatient candidates for treatment
For outpatient treatment, antibiotic selection is driven by presence or absence comorbid health conditions (chronic lung/kidney/liver disease, DM, immunocompromised state, alcoholism, asplenia)
- No comorbidities: High dose amoxicillin, doxycycline, azithromycin
- Comorbidities: augmentin, cephalosporin, doxycycline, macrolide with fluoroquinolones as an alternatives
For inpatient treatment, standard treatment is a macrolide and 3rd-generation cephalosporin
- Prior MRSA isolate or pseudomonas isolate as well as severe pneumonia are indications for adding MDR organism coverage with vancomycin and anti-pseudomonal coverage

References

Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST

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

Donate to EMM today!

Podcast 678: ECMO for Refractory VFib Jun 08, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac cath vs. typical resuscitation
After 30 patients (15 each arm), the trial was stopped because such a significant benefit seen in the ECMO arm
6 patients survived and 3 had good neurological outcomes at 6 months with ECMO
This is compared to 1 patient surviving initially and none surviving at 6 months in the typical resuscitation arm

References

Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2

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