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 535: A Prescription for Falls Jan 28, 2020

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Emergency department evaluation of falls, particularly in the elderly, should include an assessment of risk factors

Common causes of falls in the elderly include medications. Review medication list for sedating medications amongst others

Consult with your hospital physical therapist to discuss fall prevention techniques with the patient

One study has shown that a comprehensive interdisciplinary approach to geriatric falls in the ED can reduce return visits and hospital admissions.

References

Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc. 2004;52(9):1417–23.

Albert M, Rui P, McCaig LF. Emergency department visits for injury and illness among adults aged 65 and over: United States, 2012-2013. NCHS Data Brief. 2017;(272):1–8.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Mental Health Monthly #1: Decision Making Capacity Jan 22, 2020

Show notes

In the first episode of this new series, the complexities of decision making capacity are discussed.

References and Further Reading:

[1] Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840.

[2] Etchells, E., Darzins, P., Silberfeld, M., Singer, P. A., McKenny, J., Naglie, G., ... & Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of general internal medicine, 14(1), 27-34.

Joint Centre for Bioethics - Aid to Capacity Evaluation (ACE)

Podcast 534: Nerve Agents Jan 21, 2020

Show notes

Author: Michael Hunt, MD

Educational Pearls:

Organophosphate "nerve agents" were developed in the 1930's
These agents have cholinergic effects, which can be remembered by the mnemonic "SLUDGE"
- Salivation
- Lacrimation
- Urination
- Defecation
- GI cramping
- Emesis
The "SLUDGE" toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis
Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis
Treatment includes atropine to reduce secretions (often in incredibly high doses) and pralidoxime (2-PAM) to treat muscle paralysis
Benzodiazepines may be necessary for seizures

References

https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html

Michael Eddleston Novel Clinical Toxicology and Pharmacology of Organophosphorus Insecticide Self-Poisoning. Annual Review of Pharmacology and Toxicology 2019 59:1, 341-360

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 533: Hypoglycemia Jan 20, 2020

Show notes

Contributor: Dylan Luyten, MD

Educational Pearls:

Insulin related hypoglycemia can vary from a brief transient effect from short-acting forms (i.e. insulin lispro) to prolonged from long acting (i.e. insulin glargine), and will require different treatment and/or observation
Of oral glycemic agents, sulfonylureas are a common culprit while metformin is rarely a cause
Sulfonylureas also deserve attention because in pediatric patients, they can be lethal even with a single ingestion, but also can cause severe hypoglycemia in adults
Hypoglycemia in non-diabetics usually occurs in the malnourished, or in those with liver or adrenal disease

References

Klein-Schwartz W, Stassinos GL, Isbister GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol. 2016;81(3):496–504. doi:10.1111/bcp.12822

Tourkmani AM, Alharbi TJ, Rsheed AMB, AlRasheed AN, AlBattal SM, Abdelhay O, Hassali MA, Alrasheedy AA, Al Harbi NG, Alqahtani A. Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article. Diabetes Metab Syndr. 2018 Sep;12(5):791-794. doi: 10.1016/j.dsx.2018.04.004. Epub 2018 Apr 12.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 532: SVC Syndrome Jan 14, 2020

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing, and parasthesias
Common causes of SVC syndrome include lung cancer, lymphoma, and thymoma
Keep SVC syndrome on the differential for all patients with facial or upper extremity swelling

References

The superior vena cava syndrome: clinical characteristics and evolving etiology. Rice TW, Rodriguez RM, Light RW. Medicine (Baltimore). 2006;85(1):37.

Diagnosis and management of superior vena cava syndrome. Markman M. Cleve Clin J Med. 1999;66(1):59.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 531: Migraine Cocktail Jan 13, 2020

Show notes

Contributor: Don Stader, MD

Educational Pearls:

The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.
The most effective agent in the cocktail is a dopaminergic agent
Routine IV fluids have not shown efficacy
There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl)
Decadron reduces rebound headache
Consider trigger point injections for those with migraine attributable to cervical neck pain.

References

Jones CW, Remboski LB, Freeze B, Braz VA, Gaughan JP, McLean SA..Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial. Ann Emerg Med. 2019 Feb;73(2):150-156. doi: 10.1016/j.annemergmed.2018.09.004. Epub 2018 Oct 26.

Friedman BW, Cabral L, Adewunmi V, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016;67(1):32–39.e3. doi:10.1016/j.annemergmed.2015.07.495

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 530: Anion Gap Acidosis + Metformin Toxicity Jan 08, 2020

Show notes

Contributor: Don Stader, MD

Educational Pearls:

The common causes of anion gap metabolic acidosis include (MUDPILES)
- Metformin, Methanol
- Uremia
- DKA
- Paraldehyde
- INH/Iron
- Lactate
- Ethylene Glycol
- Salicylate
Metformin is a very common drug used to treat type 2 diabetes, however in the right setting, it can cause a profound lactic acidosis. There is a very high mortality rate.
Treatment of metformin toxicity includes fluids, bicarb, and dialysis
Most commonly, metformin toxicity is in the setting of kidney injury or overdose.
Always consider acidosis in those with tachypnea!

References

Re-evaluation of a biguanide, metformin: mechanism of action and tolerability. Sirtori CR, Pasik C Pharmacol Res. 1994;30(3):187.

Bicarbonate haemodialysis as a treatment of metformin overdose.Heaney D, Majid A, Junor B. Nephrol Dial Transplant. 1997;12(5):1046.

Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup.Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, Hoffman RS, Nolin TD, Ghannoum M, Extracorporeal Treatments in Poisoning Workgroup Crit Care Med. 2015;43(8):1716.

Metformin accumulation: lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy.Vecchio S, Giampreti A, Petrolini VM, Lonati D, Protti A, Papa P, Rognoni C, Valli A, Rocchi L, Rolandi L, Manzo L, Locatelli CA Clin Toxicol (Phila). 2014;52(2):129.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 529: Hemophilia Jan 08, 2020

Show notes

Contributor: Aaron Lessen, MD

Educational Pearls:

Hemophilia is characterized by bleeding (A /B) A is is 8, B (chrstmas, 9)
Hemophilia refers to a group of bleeding disorders caused by a deficiency in a certain clotting factor. The two most common are hemophilia A (caused by a lack of factor VIII), and B (caused by a lack of factor 9)
Most cases are inherited in an X-linked recessive manner. Therefore, males are the most commonly affected. However, spontaneous cases do occur in all sexes.
People with hemophilia can present to the ED with a variety of bleeding complications including hemarthrosis, intracranial hemorrhage, and GI bleeds.
Treatment is guided by the type of hemophilia and the degree of bleeding, with the most severe cases being treated with replacement of 100% of that person's deficient clotting factor.
Timely treatment improves outcomes, so consider empiric therapy in those with known hemophilia

References

Hemophilia A in the third millennium.Franchini M, Mannucci PM Blood Rev. 2013 Jul;27(4):179-84. Epub 2013 Jun 28.

Rheumatic manifestations of hematologic disorders.Aviña-Zubieta JA, Galindo-Rodriguez G, Lavalle C Curr Opin Rheumatol. 1998;10(1):86.

The molecular genetics of hemophilia: blood clotting factors VIII and IX.Lawn RM Cell. 1985;42(2):405.

Guidelines for the management of hemophilia.Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A, Treatment Guidelines Working Group on Behalf of The World Federation Of Hemophilia Haemophilia. 2013 Jan;19(1):e1-47. Epub 2012 Jul 6.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 528: Decompensated Liver Failure Jan 06, 2020

Show notes

Contributor: Michael Hunt, MD

Educational Pearls:

Cirrhosis is the end stage of chronic structural damage to the liver. This is most commonly due to alcohol but other causes viral hepatitis and hepatotoxic drugs
Cirrhotic patients are very prone to GI bleeding and infections, partially due to the role the liver plays in producing immune and clotting factors
These patients can easily become "sick". Use the shock index (heart rate / systolic blood pressure) as a rapid assessment of hemodynamic status. >0.7 is worrisome, >1 should prompt resuscitation.
Because cirrhotic patients are immunocompromised, do not rely on the presence of fever and peritonitis to diagnose spontaneous bacterial peritonitis (SBP), and have a low threshold to perform a diagnostic paracentesis
Polymorphonuclear (PMN) count > 250 in the ascitic fluid suggests SBP
With GI bleeding in cirrhotics, antibiotics have a mortality benefit, while PPIs and octreotide have limited benefit

References

Chinnock B, Hendey GW, Minnigan H, Butler J, Afarian H. Clinical impression and ascites appearance do not rule out bacterial peritonitis. J Emerg Med. 2013 May;44(5):903-9. doi: 10.1016/j.jemermed.2012.07.086. Epub 2013 Mar 7.

Pericleous M, Sarnowski A, Moore A, Fijten R, Zaman M. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. Eur J Gastroenterol Hepatol. 2016 Mar;28(3):e10-8. doi: 10.1097/MEG.0000000000000548.

Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M.Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther. 2011 Sep;34(5):509-18. doi: 10.1111/j.1365-2036.2011.04746.x. Epub 2011 Jun 27.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Podcast 527: Knee Dislocations Jan 03, 2020

Show notes

Contributor: Erik Verzemnieks, MD

Educational Pearls:

Knee dislocations are most common in high energy trauma, such as a motor vehicle accident
The knee may appear grossly normal on initial inspection since dislocations can spontaneously reduce - Look for such findings as hemarthrosis, instability, or ecchymosis, as clues to an occult dislocation.
Knee dislocations are often associated with damage to the popliteal artery that runs behind the knee.
Assess for pulse deficit on exam. If you are concerned - use the ankle-brachial index (normal >0.9). If the ABI is abnormal, evaluate with CT angiogram and a vascular surgery consult.

References

Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004 Jun;56(6):1261-5.

Steele HL, Singh A. Vascular injury after occult knee dislocation presenting as compartment syndrome. J Emerg Med 2012; 42:271.

Sillanpää PJ, Kannus P, Niemi ST, et al. Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study. J Trauma Acute Care Surg 2014; 76:715.

Summarized and written by myself

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected