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 650: PNES Mar 22, 2021

Show notes

Contributor: Katie Sprinkel, MD

Educational Pearls:

Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause
Despite common assumption, PNES are not always volitional
20-40% of those with PNES can also have true epileptic seizures 20-40%
True diagnosis requires a video EEG
Characteristics of PNES include:
- Waxing and waning of the seizure intensity
- Eyes clenched shut
- Pelvic thrusting, rolling from side-to-side
- Ability to respond to verbal stimuli during the seizure
- Ability to recall information during the seizure
- Weeping or stuttering
- Guarding the face on passive hand drop
Characteristics of epileptic seizures:
- Tongue biting
- Prolonged postictal state
- Incontinence
Haldol or Zyprexa may be better for PNES and benzodiazepines tend to be better for epileptic seizures

References

Huff JS, Murr N. Psychogenic Nonepileptic Seizures. 2021 Jan 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28722901.

Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017 Jun;38(6):935-940. doi: 10.1007/s10072-017-2887-8. Epub 2017 Mar 8. PMID: 28275874.

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

Trauma Is A Journey #4 Coming Full Circle Mar 20, 2021

Show notes

High in the mountains of Colorado, a crew of unsuspecting docs stumble upon the EMS scene of a head-on collision after an arduous mountain bike ride. Trauma is a Journey is a four part rural trauma mini series that recounts this tale as this group springs into action to assist the EMS crews dealing with two critical patients. Elizabeth Esty hosts a panel discussion with the key players: Dr. Dylan Luyten, Dr. JP Brewer, Dr. Madison Macht, Dr. Glenda Quan and Jeremiah Grantham as this story unfolds.

This final episode explores how addressing psychological and emotional trauma is the final step in a patient's journey once their physical illnesses have been addressed. The group discusses how this can take time and how they support patients through these tough journeys. Dr. Luyten brings everything full circle as he recounts his own story of being a patient in a rural car crash and how that experience affected him and ultimately set him on a path to become an ER physician. This episode also emphasizes the need for healthcare professionals to support each other through debriefs to prevent burnout and remain resilient themselves when providing care.

Thank you all for listening!

Trauma Is A Journey #3 What's In Your Jump Kit Mar 19, 2021

Show notes

The third episode opens up with an ode to ATLS and how important those training protocols really are to real-world applications like the one in this story. The group segues into discussion of the various opinions on the essentials for emergency first aid supplies you should have on hand. Dr. JP Brewer circles back to the role of teamwork and establishing roles in order to accomplish a successful resuscitation and the others chime in based on their experiences.

Trauma is a Journey #2 The Complete Antidote to Burnout Mar 18, 2021

Show notes

This second episode follows the patients as they arrive to St. Vincent, a small critical access hospital in Leadville, the next stop on their journey. Teamwork is the main theme throughout this episode as these doctors work to stabilize these patients and coordinate air transport to definitive care at Level 1 Trauma Center Swedish Medical Center. Dr. Quan goes into detail about the extent of the patients' internal injuries, the role of damage control surgery in their management and how appropriate pre-hospital management is crucial for these critical trauma patients.

Trauma is a Journey #1 Setting the Scene Mar 17, 2021

Show notes

High in the mountains of Colorado, a crew of unsuspecting docs stumble upon the EMS scene of a head-on collision after an arduous mountain bike ride. Trauma is a Journey is a four part rural trauma mini series that recounts this tale as this group springs into action to assist the EMS crews dealing with two critical patients. Elizabeth Esty hosts a panel discussion with the key players: Dr. Dylan Luyten, Dr. JP Brewer, Dr. Madison Macht, Dr. Glenda Quan and Jeremiah Grantham as this story unfolds.

In this first episode, the scene is set for the arc of this storyline and while the journey of these patients is the primary focus, the doctors involved come to realize that this experience also took them on a journey as they debrief the events following their ride. Tune in for discussion of the pre-hospital management and insightful commentary on the situation as a whole.

Podcast 649: Normal Triage EKGs Mar 16, 2021

Show notes

Contributor: Samuel Killian, MD

Educational Pearls:

Anecdotally, when the computer reads a triage EKG as normal it is most often normal
One study tested this theory by examining 855 computer-read EKGS (222 of which were read as normal)
Two cardiologists reviewed these 222 normal EKGs and only found 13 EKGs that were slightly abnormal with nonspecific abnormalities
Two EM physicians then reviewed these EKGs and only one physician on one EKG said they would change the patient's course of care by rooming them faster
The study may support eliminating physician review of normal triage EKGs as a safe practice that would decrease physician interruption

References

Hughes KE, Lewis SM, Katz L, Jones J. Safety of Computer Interpretation of Normal Triage Electrocardiograms. Acad Emerg Med. 2017 Jan;24(1):120-124. doi: 10.1111/acem.13067. PMID: 27519772.

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

Podcast 648: Ivermectin for COVID-19 Mar 15, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Ivermectin is an antiparasitic medication that has been used for a long time, but has sparked new interest in the past year as a potential treatment for COVID-19
In-vitro studies have shown it decreases how quickly COVID replicates and may make it less likely to adhere to cells
Observational studies have found lower rates of COVID-19 infections in areas that provide ivermectin prophylaxis
In several studies it was shown that it decreased severity and mortality, though there were significant methodological limitations
NIH gave a statement saying there is not enough evidence to support or refute based on current trials and larger more rigorous trials are needed

References

Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020 Jun;178:104787. doi: 10.1016/j.antiviral.2020.104787. Epub 2020 Apr 3. PMID: 32251768; PMCID: PMC7129059.

Hellwig MD, Maia A. A COVID-19 prophylaxis? Lower incidence associated with prophylactic administration of ivermectin. Int J Antimicrob Agents. 2021 Jan;57(1):106248. doi: 10.1016/j.ijantimicag.2020.106248. Epub 2020 Nov 28. PMID: 33259913; PMCID: PMC7698683.

Rajter JC, Sherman MS, Fatteh N, Vogel F, Sacks J, Rajter JJ. Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019: The Ivermectin in COVID Nineteen Study. Chest. 2021 Jan;159(1):85-92. doi: 10.1016/j.chest.2020.10.009. Epub 2020 Oct 13. PMID: 33065103; PMCID: PMC7550891.

Chaccour C, Casellas A, Blanco-Di Matteo A, Pineda I, Fernandez-Montero A, Ruiz-Castillo P, Richardson MA, Rodríguez-Mateos M, Jordán-Iborra C, Brew J, Carmona-Torre F, Giráldez M, Laso E, Gabaldón-Figueira JC, Dobaño C, Moncunill G, Yuste JR, Del Pozo JL, Rabinovich NR, Schöning V, Hammann F, Reina G, Sadaba B, Fernández-Alonso M. The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trial. EClinicalMedicine. 2021 Feb;32:100720. doi: 10.1016/j.eclinm.2020.100720. Epub 2021 Jan 19. PMID: 33495752; PMCID: PMC7816625.

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

UnfilterED #12: Dr. Don Stader Mar 10, 2021

Show notes

If you listen to this podcast, then you're probably familiar with our founder and frequent contributor, Dr. Donald Stader, and his fascination with the intersection of Emergency Medicine, opioids and Addiction Medicine. He is board certified in both specialties and is an active clinician in the ED that is constantly working to improve systems of best practice surrounding opioid uses there and in other specialties. In this episode of UnfilterED, Nick touches on these topics briefly before diving much deeper into the evolution of Don's perspectives on life and death in the context of his mother's recent passing due to COVID-19.

Tune in to hear Don's unfiltered personal account that can only be described as real, raw and relevant.

Time Stamps

1:35 Don introduction

3:00 Opioid epidemic impacted by COVID

10:00 Upcoming Don projects and the role of stories

14:42 Sources of aspirational inspiration

34:07 Mother's death and learning how to die

49:12 Ending on a happier note

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 647: INR and Liver Failure Mar 09, 2021

Show notes

Contributor: Erik Verzemnieks, MD

Educational Pearls:

INR measures the clotting cascade including factors II, VII, IX, and X
Coumadin most commonly elevates the INR, and it is used to monitor the anticoagulant's effectiveness
Liver failure can cause a similar elevation in the INR due to lack of synthesis of factors II, VII, IX, X
An elevated INR in liver failure does not mean that the patient is anticoagulated, at increased risk for bleeding, or is at less risk of forming a clot
There is more commonly an increased risk of clot formation due to lack of production of protein C and S, which are natural anticoagulants
Lack of production of proteins C and S have a larger effect and lead to typically a net clotting risk
Levels of these can be indirectly measured through albumin
Portal venous thrombosis is one of the most common examples of this phenomenon

References

Harrison MF. The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting. West J Emerg Med. 2018;19(5):863-871. doi:10.5811/westjem.2018.7.37893

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

Donate to EMM today!

Podcast 646: Thunderclap Headache, Think...RCVS? Mar 08, 2021

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

When evaluating a thunderclap headache, don't forget RCVS!
- RCVS: reversible cerebral vasoconstriction syndrome
- Due to reversible spasms of cerebral blood vessels
Can sometimes be seen on CTA or MRA, but often the imaging is normal and formal angiograms only occasionally show it
It can be caused by medications, intense physical activity, orgasm, and postpartum conditions, but the exact etiology is unknown
Typically seen in females in their 40s
Can result in bleeding, strokes, and seizures
There is no good treatment, but stopping the suspected offending agent may help

References

Sattar A, Manousakis G, Jensen MB. Systematic review of reversible cerebral vasoconstriction syndrome. Expert Rev Cardiovasc Ther. 2010;8(10):1417-1421. doi:10.1586/erc.10.124

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

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