Emergency Medical Minute

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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:

CBHW Summit: Benzos - Boon or Blunder? Nov 26, 2019

Show notes

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

Contributor: Steven Wright, MD, Colorado Consortium for Prescription Drug Abuse Prevention

Podcast 519: Malaria Drug Resistance Nov 19, 2019

Show notes

Contributor: John Winkler

Educational Pearls:

There is increasing resistance to antimalarial drugs, especially in P. falciparum. This trend started with chloroquine, but is now spreading to the other first-line drugs.
Resistant strains have been identified in Cambodia and Thailand
220 million people were infected last year
The best treatment of malaria is prevention from bites - DEET and permethrin are typical effective options.
Permethrin may be applied to clothing items before travel, and will last through 6-8 wash cycles.
While malaria is rare in the US, it should be considered in those having recently travelled

References

Hamilton WL, Amato R, van der Pluijm RW, et al. Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study. Lancet Infect Dis. 2019;19(9):943–951. doi:10.1016/S1473-3099(19)30392-5

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

Podcast 518: Professional Complications Nov 16, 2019

Show notes

Contributor: Jared Scott, MD

Educational Pearls

In a 4 yr period at 2 hospital systems, unprofessional behavior of surgeons was monitored via a complaint system. Number of complaints was compared with surgical complications.
In 13000 patients over this period, the number of surgical complications was found to vary with the number of complaints. Surgeons with with zero complaints had a 10% complication rate, 1-3 complaints had a 14% rate, and those with >4 and an 11.9% rate.
There was statistical significance that persisted after adjustment for a variety of patient factors
It never hurts to be professional!

References

Cooper WO, Spain DA, Guillamondegui O, et al. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg. 2019;154(9):828–834. doi:https://doi.org/10.1001/jamasurg.2019.1738

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

Podcast 517: It's all about the PEEP Nov 12, 2019

Show notes

Contributor: Dylan Luyten, MD

Educational Pearls:

Bag-valve masks (BVM) typically have a port to connect O2 to. Unfortunately room air becomes entrained in the mask, reducing the FiO2 delivered to the patient. This can be overcome by using a PEEP (positive end-expiratory pressure) valve on the BMV
PEEP valves function by keeping alveoli open in the lungs at the end of expiration. This increases the oxygen diffusing ability of the lungs, keeping patients' oxygen saturations higher.
Patients who are critically ill can become quickly hypoxic after RSI meds due to reduced functional residual lung capacity - an issue that can be overcome with a PEEP valve
PEEP also will reduce work of breathing in COPD and CHF patients

References

Bucher JT, Cooper JS. Bag Mask Ventilation (Bag Valve Mask, BVM) [Updated 2019 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441924/

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

UnfilterED #2: Lisa Raville & Dr. Josh Blum Nov 09, 2019

Show notes

Lisa Raville and Dr. Josh Blum, two pioneers of harm reduction in Denver, discuss the addiction crisis, the current state of harm reduction and how it will evolve in the future.

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 516: Narcan and Pulmonary Edema Nov 07, 2019

Show notes

Contributor: Erik Verzemnieks, MD

Educational Pearls:

Important to realize complications can occur in the post-opioid overdose patient regardless of cause
Narcan administration has been associated with non-cardiogenic pulmonary edema, although the mechanism of this is not quite known
Symptoms include progressive shortness of breath and hypoxia.
Treatment is with positive-pressure ventilation and diuresis, similar to cardiogenic causes
Though rare, it would appear this typically resolves with treatment

Reference

Jiwa N, Sheth H, Silverman R. Naloxone-Induced Non-Cardiogenic Pulmonary Edema: A Case Report. Drug Saf Case Rep. 2018;5(1):20. Published 2018 May 10. doi:10.1007/s40800-018-0088-x

All by Erik Verzemnieks, MD

Podcast 515: Non-Accidental Trauma Nov 01, 2019

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Non-accidental trauma (NAT) to children is commonly missed by medical providers
Try to remember TEN-4-FACES as a useful aide for concerning patterns that may reflect NAT:
- Torso, ears, neck and any bruising in child 4 months or longer
- Frenulum, angle of the mandible, cheek, eyes, sclera

References

Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT. The Prevalence of Bruising Among Infants in Pediatric Emergency Departments. Ann Emerg Med. 2016 Jan;67(1):1-8. PMID: 26233923.

Pierce MC, Kaczor K, Aldridge S, O'Flynn J, Lorenz DJ. Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics. 2010 Jan;125(1):67-74. PMID: 19969620.

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

Podcast 514: Pain Control While on Naltrexone Oct 30, 2019

Show notes

Author: Don Stader, MD

Educational Pearls:

Suboxone, methadone, and naltrexone are commonly used as treatments for opiate use disorder.
Naltrexone is a full mu-opiate receptor antagonist, making acute pain control difficult in patients taking it.
Options for pain control in patients on naltrexone include nerve blocks, NSAIDS, ketamine, and high doses of opiates.
Of the opiates, Dilaudid (hydromorphone) has the highest affinity for mu-opiate receptors, and will be the most effective.

References

Vickers AP, Jolly A. Naltrexone and problems in pain management. BMJ. 2006;332(7534):132–133. doi:10.1136/bmj.332.7534.132

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

Podcast 513: Plague Oct 27, 2019

Show notes

Author: John Winkler, MD

Educational Pearls:

The plague (black death) is caused by the Yersinia Pestis bacteria. This bacteria is spread by fleas and carried by rats. It is very contagious and only needs ~ 100 bacteria to cause an infection.
The pulmonary form presents with cough, fever, night sweats, hemoptysis and has a near 100% fatality rate if not treated in the first day of symptoms
The bubonic form causes buboes, which are necrotic, purulent lymph nodes that can lead to sepsis.
Prairie dogs are a common carrier in modern times

References

https://www.cdc.gov/plague/index.html

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

Podcast 512: Abstinence is Bad, mmmkay? Oct 22, 2019

Show notes

Author: Don Stader, MD

Educational Pearls:

Abstinence from substances such as tobacco or alcohol are effective strategies to achieve long term sobriety
However, abstinence is not an effective strategy for achieving sobriety with opiate use disorder (OUD)
Up to 90% of those who use an abstinence-only strategy for OUD will relapse within a month.
Attending a rehabilitation facility increases mortality in those with OUD due to decreased tolerance and higher rates of overdose.
Medication-assisted therapy (MAT) with naltrexone, buprenorphine or methadone for OUD is supported by evidence, and is the preferred method for achieving remission

References

Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev. 2016 May 9;(5):CD011117. doi: 10.1002/14651858.CD011117.pub2. Review. PubMed PMID: 27157143.

Medications for Opioid Use Disorder Save Lives. 2019 Mar 30;. doi: 10.17226/25310. Review. PubMed PMID: 30896911.

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

Music credit: "Smooth Lovin" by Kevin MacLoed (incompetech.com). Licensed under Creative Commons By Attribution 3.0 License. http://creativecommons.org/licenses/by/3.0/

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