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 526: Desmopressin for Intracranial Hemorrhage Dec 30, 2019

Show notes

Contributor: Charleen Melton, PharmD

Educational Pearls:

Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works by increasing the release of Von Willebrand factor, helping to stabilize clots.
The use of DDAVP for intracranial hemorrhage in patients on antiplatelet agents (mainly Aspirin and Plavix) was recently reviewed
In this retrospective review, they found an 88% decreased likelihood of hemorrhage expansion, in those who received DDAVP, compared to those who did not. Furthermore, they found no significant increase in adverse effects like hyponatremia or thrombosis
However, no difference in mortality or neurological status was found
DDAVP for intracranial hemorrhage in the setting of antiplatelet agents may be safe and reduce the expansion of intracranial bleeds but not change important patient outcomes

References

Feldman EA et al. Retrospective assessment of desmopressin effectiveness and safety in patients with antiplatelet-associated intracranial hemorrhage. Crit Care Med 2019 Sep 24; [e-pub]

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

Podcast 525: Enjoyable Epistaxis? Dec 24, 2019

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

The ED is full of painful procedures. One of the most commonly dreaded procedures is nasal packing for epistaxis, as it is quite uncomfortable for the patient.
A recent study compared TXA with compression, saline with compression, and traditional nasal packing for the treatment of epistaxis.
Hemostasis was achieved in 91% with TXA and compression, 93% with nasal packing, and 71% with saline and compression. There was no statistically significant difference between the packing and TXA groups.
Furthermore, there was no difference in rates of rebleeding between the TXA and packing groups. However, 15% of nasal packing patients demanded removal of the packing due to pain.
Consider TXA (on gauze or atomized) for your next patient with epistaxis!

References

Akkan, Sedat et al.. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Annals of Emergency Medicine, Volume 74, Issue 1, 72 - 78

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

Podcast 524: Bacterial Endocarditis Dec 20, 2019

Show notes

Contributor: Sue Chilton, MD

Educational Pearls:

More intracardiac devices and injection drug abuse are thought to be increasing incidence of endocarditis
Classic signs of endocarditis have included: Osler nodes (painful hemorrhagic lesions on hands and feet), Janeway lesions (painless hemorrhagic lesions on the hands and feet), and splinter hemorrhages in the nail beds
Other classic findings like fever and murmur are variable
More non-specific symptoms can include flu-like symptoms
Patients who inject drugs are at higher risk for this diagnosis

References

Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, Mehta JL Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070.

Infective endocarditis. Cahill TJ, Prendergast BD Lancet. 2016;387(10021):882. Epub 2015 Sep 1.

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

Podcast 523: A Dizzying Diagnosis Dec 17, 2019

Show notes

Contributor: Don Stader, MD

Educational Pearls:

It can be difficult to distinguish between central and peripheral causes of vertigo. Cerebellar stroke should be considered with any dizzy patient.
Signs and symptoms that suggest stroke as the cause of vertigo include: ataxia, cranial nerve deficits, and rapid onset of symptoms
When cerebellar stroke is being considered, MRI is the imaging modality of choice since CT does not adequately visualize the posterior fossa.

References

Kim J, Lee H. Vertigo due to posterior circulation stroke. Semin Neurol. 2013 Jul;33(3):179-84. doi: 10.1055/s-0033-1354600. Epub 2013 Sep 21.

UnfilterED #3: Dr. Katie Bakes & Dr. Pete Bakes Dec 14, 2019

Show notes

Husband and wife Pete and Katie Bakes, both emergency physicians in the Denver-Metro area, reflect on their upbringings, the many lessons learned over their twenty year careers, and how they've evolved as physicians and as a couple in this very special episode of UnfilterED.

Time Stamps:

00:25 - Intros

03:05 - How did you two meet?

08:20 - (P) How have you seen Katie develop and change over the course of her medical career?

12:00 - (K) As a young woman, how did you balance your professional aspirations with your desire to start a family?

17:04 - (K) How have you seen Pete develop and change over the course of his medical career?

21:41 - Fostering and maintaining empathy over the course of a medical career

33:55 - How has medicine impacted the way you raise your children?

38:55 - Pete's experience as a 1st generation American

53:04 - How medicine has shaped Katie's faith and spirituality

1:00:24 - What is the purpose of suffering?

1:05:02 - Community vs. Academic medicine

1:09:40 - "The Award Winning Dr. Bakes"

1:12:40 - Extra-Clinical Pursuits

Intro Music:

Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

Podcast 522: e-Cigarette and Vaping Related Lung Injury Dec 10, 2019

Show notes

Contributor: John Winkler, MD

Educational Pearls:

Vaping-related lung injury initially presents with flu-like symptoms and can progress to respiratory failure requiring aggressive resuscitation including ECMO
It is thought to be related to the contents of homemade vaping fluid, mostly in THC-containing products ("brands" include DankVapes, PaxPen)
Ask patients with vague constitutional or respiratory symptoms about their vape use

References

What are the respiratory effects of e-cigarettes? Gotts JE, Jordt SE, McConnell R, Tarran R BMJ. 2019;366:l5275. Epub 2019 Sep 30.

Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report.Layden JE, Ghinai I, Pray I, Kimball A, Layer M, Tenforde M, Navon L, Hoots B, Salvatore PP, Elderbrook M, Haupt T, Kanne J, Patel MT, Saathoff-Huber L, King BA, Schier JG, Mikosz CA, Meiman J N Engl J Med. 2019;

Vaping-Associated Acute Lung Injury: A Case Series. Triantafyllou GA, Tiberio PJ, Zou RH, Lamberty PE, Lynch MJ, Kreit JW, Gladwin MT, Morris A, Chiarchiaro J. Am J Respir Crit Care Med. 2019;

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

Podcast 521: Traumatic Hyphema Dec 05, 2019

Show notes

Author: Jared Scott, MD

Educational Pearls:

A hyphema is blood in the anterior chamber of the eye, typically caused by trauma
While there is a spectrum of disease, blurred vision and eye pain are common presenting complaints after direct trauma to the eye
Hyphema are graded between Grade 1 and Grade 5, depending on the amount of blood in the anterior chamber. Higher grades are associated with worse outcomes and more complications
Other important diagnoses to consider include globe rupture and retrobulbar hematoma
Complications of a hyphema can include glaucoma and vision loss

References

Brandt MT, Haug RH.Traumatic hyphema: a comprehensive review. J Oral Maxillofac Surg. 2001 Dec;59(12):1462-70.

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

Podcast 520: Approach to the arresting patient Dec 03, 2019

Show notes

Contributor: Peter Bakes, MD

Educational Pearls:

Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical
The differential for near cardiac arrest includes the "H's and T's", just as in true cardiac arrest
The 6 H's include: hypoxia, hypo/hyperkalemia, hypovolemia (including shock states), hydrogen (acidosis), hypothermia
The 6 T's include: tension pneumothorax, cardiac tamponade, thrombus (PE/MI), toxins, trauma
Use your history skills to narrow down this list (i.e renal failure leads to hyperkalemia, trauma leads to tension pneumothorax or tamponade)

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

CBHW Summit: The Cycle of Drug-Related Stigma - Implications for the Opioid Crisis Nov 27, 2019

Show notes

From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributor:

Michael Miller, Strategic Initiatives Coordinator, Jefferson County Public Health

CBHW Summit: A Strategic Framework for Addiction Medicine Nov 27, 2019

Show notes

From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributors: Judith Shlay, MD, MSPH, Associate Director, Denver Public Health, and Brooke Bender, MPH, Center for Addiction Medicine Planner, Denver Health

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