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 677: Oatmeal Cream for Hand Eczema Jun 07, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Hand eczema is present in about 10% of the population and has a great prevalence in hairdressers, healthcare workers, and food service employees
Using 1% oatmeal cream instead of a base cream showed statistically significant improvement in outcomes of HE in healthcare workers in a double-blind study

References

Sobhan M, Hojati M, Vafaie SY, Ahmadimoghaddam D, Mohammadi Y, Mehrpooya M. The Efficacy of Colloidal Oatmeal Cream 1% as Add-on Therapy in the Management of Chronic Irritant Hand Eczema: A Double-Blind Study. Clin Cosmet Investig Dermatol. 2020;13:241-251. Published 2020 Mar 25. doi:10.2147/CCID.S246021

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.com/cme-courses/ and create an account.

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Podcast 676: Spontaneous Bacterial Peritonitis May 31, 2021

Show notes

Contributor: Sam Killian, MD

Educational Pearls:

Patients with cirrhosis and ascites are frequently evaluated for spontaneous bacterial peritonitis, an infection of the ascites fluid that is not from a surgically treated source
Fever, abdominal pain, and altered mental status should all raise clinical suspicion in a patient with ascites
Fluid from paracentesis may show increased WBCS (polys and neutrophils), high LDH, high amylase, and decreased glucose
Outcomes are very poor in these patients with 30-40% of these patients continue to renal failure with 60-80% in-hospital mortality
Typically treat with a third generation cephalosporin or ampicillin+gentamicin

References

Long B, Koyfman A. The emergency medicine evaluation and management of the patient with cirrhosis. Am J Emerg Med. 2018;36(4):689-698. doi:10.1016/j.ajem.2017.12.047

MacIntosh T. Emergency Management of Spontaneous Bacterial Peritonitis - A Clinical Review. Cureus. 2018;10(3):e2253. Published 2018 Mar 1. doi:10.7759/cureus.2253

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

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Pharmacy Phriday #10: Colorado Pharmacists Association 2020 Opioid Prescribing and Treatment Guidelines May 28, 2021

Show notes

This week's Pharmacy Phriday features a short excerpt from a longer podcast released as promo for the Colorado's CURE initiative, Clinicians United to Resolve the Epidemic, that combats the opioid crisis through education. Frequent contributor to the podcast, Rachael Duncan, PharmD, is joined by host, Elizabeth Esty, MD, to discuss the opioid prescribing guidelines for pharmacists released by the Colorado Hospital Association in collaboration with the Colorado Pharmacists Society.

Colorado's CURE focuses on four pillars:

Limiting the use of opioids in clinical practice
Using multimodal alternatives to opioids (ALTO) to better treat pain without the risks that come with opioids
Harm Reduction
Improving care for those who have developed an opioid use disorder

Access Colorado's CURE Opioid Prescribing Guidelines for Pharmacists and other specialties here!

You can listen to the full Pharmacy episode of the Colorado's CURE Podcast for a more in-depth overview of the guidelines below:

Apple

Libsyn

Podcast 675: CHF like it's 1966 May 26, 2021

Show notes

Contributor: Chris Holmes, MD

Educational Pearls:

Medicine is cyclical and practice is always evolving
A description of recommended treatment for CHF from 1966
- Give oxygen
- Give one dose morphine then switch to demerol
- Decrease venous return and start PPV
- Immediately apply tourniquet to 3 extremities rotating tourniquets every 20 minutes
- Phlebotomy of 350-500 cc blood into a donor bag and draw off plasma as RBCs settle down
- Give aminophylline (make sure it is warmed)
- Induce hypotension with nitroglycerin and trimethoprim camphorsulfonate (infused at 10 drips/minute)
- Start digitalis
- Don't use any diuretics as they are ineffective
- If in shock, release tourniquets and hang the phlebotomized blood
- Isoproterenol might be beneficial

References

Messer JV. Management of emergencies. 13. Acute cardiac decompensation. N Engl J Med. 1966;274(26):1491-1493. doi:10.1056/NEJM196606302742608

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

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Photo Credit: Photo presented without modification courtesy of Kipp Teague , CC license

Podcast 674: Facial Nerve Palsy in Kids May 25, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Facial nerve palsy (Bell's palsy) can occur in pediatric patients with Lyme disease, viral infection, or even leukemia
One trial sought out to find if steroids and acyclovir would benefit pediatric patients with facial nerve palsy
However, during screening process, around 1% of enrollees had leukemia (5 of the 644 patients)
This is important as steroids can partially treat the leukemia thereby prolonging diagnosis and put the patient at risk for tumor lysis syndrome

References

Babl FE, Kochar A, Osborn M, et al. Risk of Leukemia in Children With Peripheral Facial Palsy. Ann Emerg Med. 2021;77(2):174-177. doi:10.1016/j.annemergmed.2020.06.029

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

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Podcast 673: Leaving the ED with Naloxone May 24, 2021

Show notes

Contributor: Don Stader, MD

Educational Pearls:

Patients are more likely to survive an opioid overdose if they have naloxone
10% risk of death in the year following an opioid overdose of patients seen in the ED
Those who receive naloxone:
- Have better survival rates
- Are more likely to enter recovery
- Are more likely to use the naloxone on another person who has overdosed
Better to give the patient naloxone at discharge from the ED as rates of filling prescriptions are low
Any patient who uses illicit drugs, chronic opioid medications, or opioids with benzodiazepines are good candidates for naloxone at discharge
Remember to instruct the patient and those who live with them on how to use it

References

Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ. The Emergency Department as an Opportunity for Naloxone Distribution. West J Emerg Med. 2018;19(6):1036-1042. doi:10.5811/westjem.2018.8.38829

Olfson M, Wall M, Wang S, Crystal S, Blanco C. Risks of fatal opioid overdose during the first year following nonfatal overdose. Drug Alcohol Depend. 2018;190:112-119. doi:10.1016/j.drugalcdep.2018.06.004

Olfson M, Crystal S, Wall M, Wang S, Liu SM, Blanco C. Causes of Death After Nonfatal Opioid Overdose [published correction appears in JAMA Psychiatry. 2018 Aug 1;75(8):867]. JAMA Psychiatry. 2018;75(8):820-827. doi:10.1001/jamapsychiatry.2018.1471

http://naloxoneproject.com/

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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Podcast 672: Oxygen Things May 18, 2021

Show notes

Contributor: Aaron Lessen , MD

Educational Pearls:

Patients on 10L or more of oxygen per minute in the ICU were randomized to oxygen goals of 90% or 96% to compare 90-day mortality rates
Mortality rates were about 42% for both of oxygen target groups, indicating no significant difference

References

Schjørring OL, Klitgaard TL, Perner A, et al. Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure. N Engl J Med. 2021;384(14):1301-1311. doi:10.1056/NEJMoa2032510

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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Podcast 671: Scapula Fractures May 17, 2021

Show notes

Contributor: Adam Barkin, MD

Educational Pearls:

Represents less than 1% of all fractures that occur, although it has a significant mortality rate of 2-5%
Typically occurs in high-energy trauma and are commonly associated with high injury severity scores and other fractures
Concomitant Injuries:
- 50% have rib fracture
- 25% have clavicle fracture
- 30% have a spine fracture
- 5% have a brachial plexus injury
- 40% have a pulmonary contusion
- 30% have a pneumothorax
- 34% have a head injury
- 11% have a vascular injury

References

Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med. 2013;6(1):79-87. doi:10.1007/s12178-012-9151-x

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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Podcast 670: Operation Tat-Type May 12, 2021

Show notes

Contributor: Dave Rosenberg, MD

Educational Pearls:

In 1951, Operation Tat-Type began tattooing adults with their blood type in an effort to prepare for rapid transfusions in the time of the Cold War and the Korean War
School children in northern Indiana and areas in Utah were tattooed with their blood type beginning in 1952 under the same operation
Based on tattoos given to SS officers during WWII
This wasn't to identify who needed what blood but rather to identify who could give what blood in the event of a massive attack

References

Wolf EK, Laumann AE. The use of blood-type tattoos during the Cold War. J Am Acad Dermatol. 2008;58(3):472-476. doi:10.1016/j.jaad.2007.11.019

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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Podcast 669: VTach Storm May 11, 2021

Show notes

Contributor: Gretchen Hinson, MD

Educational Pearls:

Three episodes of ventricular tachycardia within 24 hours or two episodes back-to-back
Treat with IV amiodarone and IV beta-blockers initially as well as IV lidocaine
Correct underlying causes:
- IV magnesium for QT prolongation
- Replete potassium in hypokalemia
- Urgent revascularization in ischemia
For refractory vtach, urgent radiofrequency ablation or stellate ganglion block can be done
Last resort is placing on the patient on ECMO

References

Muser D, Santangeli P, Liang JJ. Management of ventricular tachycardia storm in patients with structural heart disease. World J Cardiol. 2017;9(6):521-530. doi:10.4330/wjc.v9.i6.521

Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J. 2011;38(2):111-121.

Summarized by John Spartz, MS3

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