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 668: Opioid-Induced Hyperalgesia May 10, 2021

Show notes

Contributor: Donald Stader, MD

Educational Pearls:

Opioids target kappa and NMDA receptors that can lead to central nervous system sensitization and therefore increased pain
For patients with opioid-induced hyperalgesia (OIH), oral ketamine (25-50 mg) can be used to treat their pain as it targets the NMDA receptor
Other treatments is IV magnesium, NSAIDs, tylenol, and clonidine
Buprenorphine and methadone are options for chronic pain management in the setting of OIH

References

Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145-161.

Summarized by John Spartz, MS3 | 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.

Donate to EMM today!

Podcast 667: Lactated Ringers for DKA May 04, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Recent study looked at whether lactated ringers might be a better choice for fluid resuscitation in patients with DKA compared to normal saline
Normal saline can cause a hyperchloremic metabolic acidosis
Time to resolution of acidosis was 4 hours less with lactated ringers compared to normal saline
Time on an insulin drip decreased by about 4 hours with lactated ringers compared to normal saline
LR might be a better choice for fluid resuscitation in patients with DKA

References

Self WH, Evans CS, Jenkins CA, et al. Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials. JAMA Netw Open. 2020;3(11):e2024596. doi:10.1001/jamanetworkopen.2020.24596

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

Podcast 666: Pain Management & Patient Perspective May 03, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

About ½ of the patients in the ED present with some form of pain
One study looked at patients presenting in pain and followed up two days after discharge to determine if their pain was addressed, asking if the patient received anything for pain and if the patient refused pain medication
Non-analgesic pain management: About 30% discordance between patient reports and documentation
Conventional analgesic pain management: About 15% discordance between patient reports and documentation

References

Taylor DM, Valentine S, Majer J, Grant N. Discordance between patient-reported and actual emergency department pain management. Emerg Med Australas. 2020 Nov 22. doi: 10.1111/1742-6723.13690. Epub ahead of print. PMID: 33225600.

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

Donate to EMM today!

Podcast 665: Allergic Reactions after COVID Vaccinations Apr 28, 2021

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Incidence 2.5-10 per million people occurring primarily in those with environmental allergens
Typically occurs with mRNA vaccines in lipid nanoparticles (Moderna/Pfizer) rather than the adenovirus vaccine (J&J)
Recommendation is to forego 2nd dose of the mRNA vaccine and instead get the adenovirus vaccine after weighing the risks and benefits

References

Kounis NG, Koniari I, de Gregorio C, Velissaris D, Petalas K, Brinia A, Assimakopoulos SF, Gogos C, Kouni SN, Kounis GN, Calogiuri G, Hung MY. Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines (Basel). 2021 Mar 5;9(3):221. doi: 10.3390/vaccines9030221. PMID: 33807579; PMCID: PMC7999280.

Blumenthal KG, Robinson LB, Camargo CA, et al. Acute Allergic Reactions to mRNA COVID-19 Vaccines. JAMA. Published online March 08, 2021. doi:10.1001/jama.2021.3976

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

Donate to EMM today!

Podcast 664: Rabies Prophylaxis Apr 27, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

1-3 cases of rabies per year in US with 55,000 people per year receiving rabies prophylaxis
90% of rabies cases come from wildlife, most commonly by racoons, bats, foxes, and skunks
Because of rabies prophylaxis, domesticated pets almost never have rabies in the United States
Rabies is typical transmitted via a bite, but direct contact with saliva or brain tissue on an open wound can transmit the virus
Some people exposed to rabies from bats will never report a bite

References

Kessels J, Tarantola A, Salahuddin N, Blumberg L, Knopf L. Rabies post-exposure prophylaxis: A systematic review on abridged vaccination schedules and the effect of changing administration routes during a single course. Vaccine. 2019 Oct 3;37 Suppl 1:A107-A117. doi: 10.1016/j.vaccine.2019.01.041. Epub 2019 Feb 5. PMID: 30737043.

Centers for Disease Control and Prevention. Rabies Postexposure Prophylaxis (PEP). Published June 11, 2019. https://www.cdc.gov/rabies/medical_care/index.html

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

Donate to EMM today!

Podcast 663: Down Syndrome Apr 26, 2021

Show notes

Contributor: Alicia Oberle, MD

Educational Pearls:

Down Syndrome with Trisomy 21 have three copies of chromosome 21
Current birth rates are around 1 in 700 births
Average life span 25 years in 1980, today the average life span is 60 years of age
Patients with Down syndrome require additional therapies in the first 3 years due to developmental delays
They also have increased risk for childhood leukemias, seizures, hypothyroidism, celiac disease, and early-onset Alzheimers
Half have a cardiac defect requiring surgery at birth

References

Tsou AY, Bulova P, Capone G, et al. Medical Care of Adults With Down Syndrome: A Clinical Guideline. JAMA. 2020;324(15):1543–1556. doi:10.1001/jama.2020.17024

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

Donate to EMM today!

UnfilterED #13: Dr. Nadia Tremonti Apr 22, 2021

Show notes

This week's episode features a fascinating conversation with Dr. Nadia Tremonti, medical director for the pediatric palliative care program at Children's Hospital of Michigan in Detroit. Dr. Tremonti was the featured physician in an independent short film Palliative and subsequent New York Times shorter excerpt Dying in your Mother's Arms that explore her work with terminally ill pediatric patients. From conversations of religion's role in processing disease to the physician's role in alleviating suffering for patients and their families, Nick and Nadia explore the existential ground in this thought-provoking segment.

Time Stamps

00:47 Introductions

3:50 How patients led her to pursue palliative care

14:32 Dr. Tremonti's approach to palliative care

21:42 Understanding patients' and family's language to guide counseling

31:38 Most frequent anxieties and fears of families of pediatric palliative care patients

37:21 How emergent interventions can shift burden of decision to continue life-sustaining measures to families

47:45 Navigating existential questions of life or death with patients and their families

55:38 Saddest part of palliative care

Donate to EMM today!

Podcast 662: Droperidol for Sedation Apr 21, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Droperidol for sedation in agitated patients in the emergency department was studied compared to ziprasidone (Geodon) and lorazepam (Ativan)
Double-blinded RCT showed droperidol was 65% effective to get patients to a good level of sedation in 15 minutes compared to ativan and geodon which were 25-35% effective
Droperidol had less respiratory depression and prolongation of the QT compared to Ativan and Geodon

References

Martel ML, Driver BE, Miner JR, Biros MH, Cole JB. Randomized Double-blind Trial of Intramuscular Droperidol, Ziprasidone, and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Acad Emerg Med. 2021 Apr;28(4):421-434. doi: 10.1111/acem.14124. Epub 2020 Oct 5. PMID: 32888340.

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

Podcast 661: Scalded Skin Syndrome Apr 20, 2021

Show notes

Contributor: Ricky Dhaliwal, MD

Educational Pearls:

Primarily affects children
Caused by staph aureus releasing exotoxins that result in erythema and sloughing of the skin
Present with significant pain, dehydration and underlying staph infection
Treatment typically oxacillin/nafcillin with admission for wound care with petroleum gel and xeroform
Burn centers may be treatment centers of choice for this condition
Most patients recover in 2-3 days with treatment

References

Patel GK, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol. 2003;4(3):165-75. doi: 10.2165/00128071-200304030-00003. PMID: 12627992.

Jordan KS. Staphylococcal Scalded Skin Syndrome: A Pediatric Dermatological Emergency. Adv Emerg Nurs J. 2019 Apr/Jun;41(2):129-134. doi: 10.1097/TME.0000000000000235. PMID: 31033660.

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

Donate to EMM today!

Podcast 660: Rhabdomyolysis Apr 19, 2021

Show notes

Contributor: Ricky Dhaliwal, MD

Educational Pearls:

Rhabdomyolysis occurs when high levels of myoglobin are released from dying muscle tissue into the blood
Severe levels of myoglobin cause renal injury
Causes include elevated temperature, excessive exercise, toxins, infection, muscle ischemia, crush injury, and prolonged immobilization
Can also be caused by medications, like antipsychotics, statins, SSRIs, colchicine, lithium
Workup typically includes creatinine kinase, potassium, creatinine levels and serial EKGs
Firstline treatment is with IV fluids with a goal urine output of 300 ml/hr
Sodium bicarbonate and mannitol have had some use in treatment but weak evidence

References

Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med. 2019 Mar;37(3):518-523. doi: 10.1016/j.ajem.2018.12.061. Epub 2019 Jan 2. PMID: 30630682.

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

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected