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 659: Racial Bias in Pulse Oximetry Apr 14, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Study in NEJM looked at occult hypoxemia, when oxygen saturation reads at >92% when the actual saturation is
Rate of occult hypoxemia was 3 times higher in those who identified as black (12% vs 4%)
Keep this disparity in mind when providing care to patients of all backgrounds and incorporate into clinical decision-making

References

Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. 2020;383(25):2477-2478. doi:10.1056/NEJMc2029240

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 658: Febrile Seizures Apr 13, 2021

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Febrile Seizure clinical criteria
- 6 months - 5 years of age
- Rapid rise in temp
- No preexisting seizure disorder
- No other explanation for the seizure
- Nonfocal seizure lasting less than 15 minutes
If the seizure does not meet the above criteria, a full workup needs to be completed
Regardless of cause, treat the seizure with IV/IO benzodiazepines or IN versed if unable to obtain access
Risk of developing epilepsy after a simple febrile seizure roughly doubles

References

Leung AK, Hon KL, Leung TN. Febrile seizures: an overview. Drugs Context. 2018;7:212536. Published 2018 Jul 16. doi:10.7573/dic.212536

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

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Podcast 657: Caustic Ingestion Apr 12, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Acid and alkali ingestions have differing prognosis and immediate concerns
Immediate issues can include superficial irritation, severe burns, esophageal perforation, and even airway compromise from edem
Long term morbidity can include strictures
Supportive care is typically all that can be provided in the emergency department
Diagnostics may include imaging and endoscopy
For more severe ingestions without immediate issues,, patients may be monitored for up to 24 hours

References

Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances. N Engl J Med. 2020 Apr 30;382(18):1739-1748. doi: 10.1056/NEJMra1810769. PMID: 32348645.

Summarized by Erik Verzemnieks, MD

Donate to EMM today!

Podcast 656: Rashes Apr 07, 2021

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Lyme disease gives a single expanding target lesion with central clearing called erythema chronicum migrans
Erythema multiforme is another targetoid rash that presents with multiple target lesions
Characterized into erythema minor and major based on severity but typically resolves
More severe hypersensitivity reactions include Stevens-Johnson Syndrome (30% skin involvement)
SJS and TEN is associated with NSAIDS including aspirin, antiemetics like phenergan, anticonvulsants like dilantin or phenobarbital, and antibiotics like penicillin or sulfa drugs
Other causes include viral illnesses like Herpes simplex virus or mycoplasma pneumoniae
Treat by removing offending agent and treat supportively with monitoring for rash progression to SJS or TEN

References

Trayes KP, Love G, Studdiford JS. Erythema Multiforme: Recognition and Management. Am Fam Physician. 2019 Jul 15;100(2):82-88. PMID: 31305041.

Read J, Keijzers GB. Pediatric Erythema Multiforme in the Emergency Department: More Than "Just a Rash". Pediatr Emerg Care. 2017 May;33(5):320-324. doi: 10.1097/PEC.0000000000000618. PMID: 26555305.

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

Donate to EMM today!

Podcast 655: Hypothermia in Sepsis Apr 06, 2021

Show notes

Contributor: Adam Barkin, MD

Educational Pearls:

Fever is an adaptive response to infection, but elderly and immunocompromised patients may not be able to mount a hyperthermic response in sepsis
Patients with fever in sepsis end up receiving treatment earlier and have better outcomes
Hypothermic patients with severe sepsis admitted to the ICU had a 32% mortality versus 21% mortality in those who had a fever on presentation
3-hour sepsis bundle compliance was less frequent in hypothermic patients than in febrile patients (56% versus 71%)
Early broad spectrum antibiotics were administered less in patients who were hypothermic than those that were febrile (77% versus 87%)

References

Blair E, Buxton RW, Cowley RA, Mansberger AR. The Use of Hypothermia in Septic Shock. JAMA. 1961;178(9):916–919. doi:10.1001/jama.1961.73040480005008b

Kushimoto S, Abe T, Ogura H, et al. Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study. Crit Care Med. 2019;47(5):691-699.

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

Donate to EMM today!

Podcast 654: Depression in COVID Apr 05, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Survey study compared depression symptom prevalence in the United States at the beginning of COVID compared to data acquired by a similar survey for 2017-2018 and found it was three-fold higher
- Mild symptoms: 25% during pandemic; 16% before
- Moderate: 15% during pandemic; 6% before
- Moderately Severe symptoms: 8% during pandemic; 2% before
- Severe symptoms: ~5% during pandemic; 1% before
Those with lower income, less savings, and exposure to more stressors were at greater risk for developing depression symptoms

References

Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686

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

Podcast 653: Nitroglycerin Disimpaction Mar 30, 2021

Show notes

Contributor: Ricky Dhaliwal, MD, JD

Educational Pearls:

Glucagon administered intravenously has a high rate of adverse events (nausea/vomiting) with very weak evidence
NItroglycerin too has very limited evidence but a much better adverse event profile
- Mix 0.4 mg (1 sublingual tablet) nitro in 10 mL of water and administer orally
Nothing beats upper endoscopy for effectiveness but in settings where GI is not immediately available, nitroglycerin may be worth an attempt given its better safety profile to other medications

References

Arora S, Galich P. Myth: glucagon is an effective first-line therapy for esophageal foreign body impaction. CJEM 2015;11:169–71

Schimmel J, Slauson S. Swallowed Nitroglycerin to Treat Esophageal Food Impaction. Ann Emerg Med. 2019 Sep;74(3):462-463.

Summarized/Edited by Erik Verzemnieks, MD

Donate to EMM today!

Podcast 652: Prosthetic Hip Dislocation Mar 29, 2021

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

While it is rare to have a native hip dislocation, it is relatively common to dislocate a prosthetic hip
The mechanism for dislocation is usually adduction, flexion, and internal rotation the hip which can occur when walking
Arthroplasty in the setting of trauma or fracture, posterior approach during surgery, and using a small femoral head increase the likelihood of later dislocation
If a patient with a total hip arthroplasty says they were walking and then developed hip pain, do not discount a potential dislocation

References

Zahar A, Rastogi A, Kendoff D. Dislocation after total hip arthroplasty. Curr Rev Musculoskelet Med. 2013;6(4):350-356. doi:10.1007/s12178-013-9187-6

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

Dr. Don Stader Shares Personal Experience of Losing his Mother to COVID-19 and Ruminates on the Culture of Death in Medicine (UnfilterED #12 Excerpt) Mar 26, 2021

Show notes

A heartfelt excerpt from our most recent UnfilterED episode with Dr. Don Stader.

Podcast 651: Hereditary Angioedema Mar 23, 2021

Show notes

Contributor: Katie Sprinkel, MD

Educational Pearls:

Hereditary angioedema (HA) is an autosomal dominant bradykinin-mediated disease affecting the airway, skin or gastrointestinal tract and typically presents with swelling in the absence of pruritus
HA episodes last 3-5 days, typically occur first in childhood or adolescence, and decrease in frequency with aging
Airway angioedema is the most dangerous but least common
Skin angioedema is usually uncomfortable and should be monitored if involving the face
GI angioedema involves nausea, vomiting, and severe abdominal pain
No definitive triggers, but episodes may be preceded by a variable prodrome but can include headache, GI symptoms, and even a rash
Treatment can include infusion of a C-1 inhibitor, such as Berinert but it is very expensive

References

Busse PJ, Christiansen SC. Hereditary Angioedema. N Engl J Med. 2020 Mar 19;382(12):1136-1148. doi: 10.1056/NEJMra1808012. PMID: 32187470.

Longhurst HJ, Bork K. Hereditary angioedema: an update on causes, manifestations and treatment. Br J Hosp Med (Lond). 2019 Jul 2;80(7):391-398. doi: 10.12968/hmed.2019.80.7.391. PMID: 31283393.

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

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