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 511: Ebola Treatment Oct 17, 2019

Show notes

Author: Rachel Beham, PharmD

Educational Pearls:

There are currently many Ebola vaccines that are being studied, and one (recombinant VZV-Ebola vaccine) is currently being used in Africa. This vaccine has so far shown good efficacy in reducing Ebola infections and mortality from Ebola in those who do become infected.
There are antibody-based treatments that are currently under investigation for the treatment of Ebola. They have been well tolerated in phase 1 trials and show some promise of efficacy.

References

Shcheblyakov D et. al. Development and characterization of two GP-specific monoclonal antibodies, which synergistically protect non-human primates against Ebola lethal infection. Antiviral Res. 2019 Oct 5:104617. doi: 10.1016/j.antiviral.2019.104617. [Epub ahead of print]

Fries L et. al. A Randomized, Blinded, Dose-Ranging Trial of an Ebola Virus Glycoprotein (EBOV GP) Nanoparticle Vaccine with Matrix-M™ Adjuvant in Healthy Adults. J Infect Dis. 2019 Oct 11. pii: jiz518. doi: 10.1093/infdis/jiz518. [Epub ahead of print]

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/

Podcast # 510: Ebola Oct 16, 2019

Show notes

Author: John Winkler, MD

Educational Pearls:

There is a new outbreak of Ebola in The Congo. This is likely due to civil war and rebel attacks on healthcare workers in the area.
Ebola is now spreading from the Congo into neighboring Uganda, but vaccination efforts are staving off the spread across the border
Early symptoms of Ebola are similar to the flu
Spread occurs through close contact with bodily fluids. Proper PPE is required when treating patients with suspected ebola

References

https://wwwnc.cdc.gov/travel/notices/alert/ebola-democratic-republic-of-the-congo

https://www.cdc.gov/vhf/ebola/symptoms/index.html

Malvy D, McElroy AK, de Clerck H, Günther S, van Griensven J. Ebola virus disease. Lancet. 2019 Mar 2;393(10174):936-948. doi: 10.1016/S0140-6736(18)33132-5. Epub 2019 Feb 15.

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/

Podcast 509: Circadian Rhythm and Shift Work, From Z to Z Oct 12, 2019

Show notes

Contributor: Jared Scott, MD

Educational Pearls:

Sleep deprivation and disturbed sleep cycles increases the risk of many acute and chronic medical issues such as motor vehicle accidents, diabetes, cardiovascular disease, psychiatric disease, and shift work sleep disorder (difficulty sleeping, fatigue, interference with daily activities)
Stages of sleep
- Stage 1: 5-10 minutes (light sleep, may not recognize).
- Stage 2: Spindle waves, mostly unstudied
- Stage 3: Restorative sleep
- Stage 4 (REM): Paralysis, memory consolidation
One sleep cycle takes about 120 minutes
Light is critical for regulating sleep cycles. Exposure to light (especially blue light) inhibits melatonin release from the pineal gland, which influences the suprachiasmatic nucleus (master sleep controller in the brain)
How can you optimize sleep before your night shifts? On the day of your first night shift, sleep until you wake naturally, then take a 90min nap between 2-6pm before you start your shift
Sleepy on shift? A 5 minute nap is helpful to increase your attention span and thinking. A 30 minute nap is good for achieving more restorative sleep. Naps between 30 and 60 minutes are not recommended due to increased sleep inertia
How do I optimize myself on shift? Keep active and take a 5 minute nap if needed. Do not use caffeine within the last 4 hours of your shift (it will interfere with your sleep!). More than 200-300mg a caffeine are not recommended, if you do use it.Use built in checks to reduce errors, as errors are increased during night shifts!
Leaving your shift, reduce exposure to light by wearing sunglasses, avoid screens and alcohol, and get to sleep ASAP
Got things to do? Remember that some sleep is better than none!

References

Kuhn G et al. Circadian rhythm, shift work, and emergency medicine. Ann Emerg Med. (2001) 37:1, 88-98.

McKenna Helen, Wilkes Matt. Optimising sleep for night shifts BMJ (2018). 360:j5637

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/

Podcast 508: Are you with child? Oct 10, 2019

Show notes

Contributor: Chris Holmes, MD

Educational Pearls:

In ancient Egypt, pregnant women would urinate over barley and wheat seeds to help determine the sex of thier fetus, as well as if they were pregnant. Amazingly, this has 70% accuracy (!!) for determining pregnancy (not sex).
Piss Prophets in the middle ages would examine urine for changes in color to determine if a woman was pregnant or not.
In the early 1900's, after discovering progesterone, and it's associated with pregnancy, the A-Z pregnancy urine test was created. Urine was collected from the woman of interest and injected into an immature rat or rabbit. If the urine put the animal into heat (due to the presence of progesterone in the urine), this was interpreted as a positive test.

References

https://history.nih.gov/exhibits/thinblueline/timeline.html

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/

Podcast 507: Who gonna crump? Oct 07, 2019

Show notes

Contributor: Nick Tsipis, MD

Educational Pearls:

Communication proves time and time again to be most helpful in preventing surprises after patient admission
Frequent re-evaluations and repeat vital signs can be important to evaluating a patient's risk for deterioration once admitted as well as selecting the proper level of care at admission
Broad categories of patients who most commonly have a change in condition after admission are septic patients and those admitted for respiratory complaints

References

Kennedy M, Joyce N, Howell MD, et al. Identifying infected ED patients admitted to the hospital ward at risk of clinical deterioration and intensive care unit transfer. Acad Emerg Med. 2010;17(10):1080–1085.

Caterino JM, Jalbuena T, Bogucki B. Predictors of acute decompensation after admission in ED patients with sepsis. Am J Emerg Med. 2010;28(5):631–636. doi: 10.1016/j.ajem.2009.04.020.

Wardi G, Wali AR, Villar J, et al. Unexpected intensive care transfer of admitted patients with severe sepsis. J Intensive Care. 2017;5:43. Published 2017 Jul 12. doi:10.1186/s40560-017-0239-7

Boerma LM, Reijners EPJ, Hessels RAPA, V Hooft MAA. Risk factors for unplanned transfer to the intensive care unit after emergency department admission. Am J Emerg Med. 2017;35(8):1154–1158.

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

UnfilterED #1: Dr. Michael Hunt Oct 07, 2019

Show notes

On the first installment of this new series, Dr. Michael Hunt shares stories, lessons and advice as he reflects on his 35 year career as an emergency physician.

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 506: Seymour Fracture Oct 03, 2019

Show notes

Contributor: Don Stader, MD

Educational Pearls:

Seymour fracture is an eponym for a Salter-Harris I/II fracture of the distal phalanx of the finger or toe in children, associated with a nailbed inury
These may present and subtle as a subungal hematoma with a fracture on x-ray but carry a significant risk of complications
While in adults a hammer-finger deformity indicates an avulsion injury of the extensor tendon, in children it can indicate disruption of the growth plate. This is coupled with disruption of the proximal nail bed.
Because these fractures affect the growth plate, they can lead to arrest of the growth plate or chronic osteomyelitis
These injuries require orthopedic consultation for possible debridement and fixation

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

Podcast 505: Sleep on Strep Throat Oct 01, 2019

Show notes

Contributor: Don Stader, MD

Educational Pearls:

Only 10% of patients receiving antibiotics for strep throat actually have the diesease
Treatment of strep with antibiotics only slightly reduces the duration of illness. Most studies say the reduction is between 16 and 24 hours
Antibiotic treatment may reduce complications such as peritonsilar abscess and otitis media but antibiotics also increase the risk of diarrhea and yeast infection
Rheumatic fever is caused by a specific serotype of strep that is no longer prevalent in the United States, so treating strep throat likely has no effect on preventing this complication

References

Anand Swaminathan, "Do Patients with Strep Throat Need to Be Treated with Antibiotics?", REBEL EM blog, January 5, 2015. Available at: https://rebelem.com/patients-strep-throat-need-treated-antibiotics/.

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

PREVIEW: UnfilterED Sep 28, 2019

Show notes

...coming October 2019

Music:

emotional by Barradeen | https://soundcloud.com/barradeen Music promoted by https://www.free-stock-music.com Creative Commons Attribution-ShareAlike 3.0 Unported https://creativecommons.org/licenses/by-sa/3.0/deed.en_US

Podcast 504: Ocular Compartment Syndrome Sep 26, 2019

Show notes

Contributor: Don Stader, MD

Educational Pearls:

The eye is surrounded by relatively inflexible tissues such as the bone of the orbit and the fibrous tissue of the eye. This makes it relatively susceptible to damage from outside compression, which is most common from trauma. This phenomenon is called ocular compartment syndrome (OCS)
Look for OCS when patients have face, head or direct eye trauma
OCS will present with a swollen, bulging eye associated with pain and blurry vision. Typically diagnosed with an elevated intraocular pressure (>40)
OCS needs to be treated with a lateral canthotomy to help expand the area around the eye, reducing the pressure.
Can't see the eye due to swelling? Use paper clips to make eyelid retractors!

References

Lima V, Burt B, Leibovitch I, Prabhakaran V, Goldberg RA, Selva D. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol. 2009 Jul-Aug;54(4):441-9. doi: 10.1016/j.survophthal.2009.04.005. Review. PubMed PMID: 19539832.

Rowh AD, Ufberg JW, Chan TC, Vilke GM, Harrigan RA. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med. 2015 Mar;48(3):325-30. doi: 10.1016/j.jemermed.2014.11.002. Epub 2014 Dec 16. PubMed PMID: 25524455.

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

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