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 #383: Prehospital Tubes Sep 24, 2018

Show notes

Author: Sam Killian, MD

Educational Pearls:

Two high quality randomized control trials published in 2018 demonstrated no difference in mortality or neurologic outcomes when using a supraglottic airway compared to endotracheal intubation in out of hospital cardiac arrest

These two trials enrolled over a combined 12000 patients

Supraglottic airways have a higher success rate than intubations

References:

Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA. 2018 Aug 28;320(8):779-791. doi: 10.1001/jama.2018.11597. PubMed PMID: 30167701

Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018 Aug 28;320(8):769-778. doi: 10.1001/jama.2018.7044. PubMed PMID: 30167699.

Podcast #382: Shoulder Separations Sep 21, 2018

Show notes

Author: Ryan Circh, MD

Educational Pearls:

A "shoulder separation" is when the clavicle separates from the scapula - also referred to as an acromio-clavicular (AC) separation

Diagnosis is clinical: pain over AC joint, pain with adduction, and difficulty raising harm past horizontal

Early range of motion can be critical for recovery

References:

Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med. 1998 Jan-Feb;26(1):137-44. Review. PubMed PMID: 9474415.

Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute Shoulder Injuries in Adults. Am Fam Physician. 2016 Jul 15;94(2):119-27. Review. PubMed PMID: 27419328.

Podcast #381: MRI... Burns? Sep 19, 2018

Show notes

Author: Sam Killian, MD

Educational Pearls:

MRI machines can generate enough heat from the radiofrequency to cause thermal burns

Patients with EKG stickers, medication patches, clothing impregnated with metallic ions, etc., can all increase risk of burns

Even skin-to-skin contact within the patient can cause a misinterpretation from the software and increased energy, leading to burn

References:

Cross NM, Hoff MN, Kanal KM. Avoiding MRI-Related Accidents: A Practical Approach to Implementing MR Safety. J Am Coll Radiol. 2018 Aug 24. pii: S1546-1440(18)30762-2. doi: 10.1016/j.jacr.2018.06.022. [Epub ahead of print] PubMed PMID: 30149951.

Takahashi T, Fujimoto N, Hamada Y, Tezuka N, Tanaka T. MRI-related thermal injury due to skin-to-skin contact. Eur J Dermatol. 2016 Jun 1;26(3):296-8. doi: 10.1684/ejd.2016.2740. PubMed PMID: 26987101.

Pietryga JA, Fonder MA, Rogg JM, North DL, Bercovitch LG. Invisible metallic microfiber in clothing presents unrecognized MRI risk for cutaneous burn. AJNR Am J Neuroradiol. 2013 May;34(5):E47-50. doi: 10.3174/ajnr.A2827. Epub 2011 Dec 15. PubMed PMID: 22173750.

Dempsey MF, Condon B. Thermal injuries associated with MRI. Clin Radiol. 2001 Jun;56(6):457-65. Review. PubMed PMID: 11428795.

Podcast #380: Oxygen for the kill Sep 17, 2018

Show notes

Author: Ryan Circh, MD

Educational Pearls:

Review of 25 randomized control trials encompassing 16,037 acutely ill hospitalized patients
Patients given oxygen with saturations > 94% on room air were found to have associated increased mortality in-hospital, at 30-days, and at long-term follow up
It may seem intuitive, but do not give oxygen to patients that do not need it

References:

Chu DK, et al (2018). Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 391(10131):1693-1705

Podcast #379: Patient Perspectives of the Flu Sep 14, 2018

Show notes

Author: Sam Killian, MD

Educational Pearls:

Patients may have certain fears or expectations about the flu based on hearsay and other less reliable sources

Taking extra time explaining the risks of the flu may help base these expectations more in reality

This includes providing good return precautions and acknowledging that the disease can still be unpredictable

Podcast #378: Is That a Brown Recluse Spider Bite? Sep 12, 2018

Show notes

Author: Michael Hunt, MD

Educational Pearls:

Use the mnemonic NOT RECLUSE to rule out a brown recluse spider bite:

Numerous bites (recluse spiders will bite once)

Occurence (recluse bites between April- October)

Timing (recluse spiders are… get this… reclusive)

Red (recluse bites are white/pale)

Elevated (recluse bites are flat)

Chronic (recluse bites are acute)

Large (recluse wounds are small)

Ulceration, early (recluse bites ulcerate between 7-14 days)

Swollen (recluse bites are flat)

Exudative (recluse bites are dry)

References:

Stoecker WV, Vetter RS, Dyer JA. NOT RECLUSE-A Mnemonic Device to Avoid False Diagnoses of Brown Recluse Spider Bites. JAMA Dermatol. 2017 May 1;153(5):377-378. doi: 10.1001/jamadermatol.2016.5665. PubMed PMID: 28199453.

Podcast #377: Endocarditis Sep 10, 2018

Show notes

Author: Nick Tsipis, MD

Educational Pearls:

Persistent fever or positive blood cultures should raise suspicion for endocarditis

Patients with recent dental procedures, recent cardiac surgeries are at risk, or who inject drugs are at higher risk

Physical exam findings may include fever with a new murmur, Janeway lesions, Osler nodes, and/or splinter hemorrhages

References:

Long B, Koyfman A. Infectious endocarditis: An update for emergency clinicians. Am J Emerg Med. 2018 Sep;36(9):1686-1692. doi: 10.1016/j.ajem.2018.06.074. Epub 2018 Jul 2. Review. PubMed PMID: 30001813.

Murdoch DR, Corey GR, Hoen B et. al. International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009 Mar 9;169(5):463-73. doi: 10.1001/archinternmed.2008.603

Podcast #376: Alcohol Intoxication Sep 08, 2018

Show notes

Educational Pearls:

Blood concentrations over 0.4 mg/dL is associated with respiratory depression and possible death in alcohol naive patients

Alcohol overdose accounts to 2,200 deaths per year

Don't forget about checking for hypoglycemia in severe alcohol intoxication

Consider ketamine for agitation to prevent further respiratory depression

Editor's note: check out our podcast on ketamine for alcohol withdrawal here

References:

Jung YC, Namkoong K. Alcohol: intoxication and poisoning - diagnosis and treatment. Handb Clin Neurol. 2014;125:115-21. doi: 10.1016/B978-0-444-62619-6.00007-0.

Centers for Disease Control and Prevention (CDC). "Vital signs: binge drinking prevalence, frequency, and intensity among adults-United States, 2010." MMWR. Morbidity and mortality weekly report 61.1 (2012): 14.

Podcast #375: Retrograde Urethrogram Sep 06, 2018

Show notes

Author: Jared Scott, MD

Educational Pearls:

Blood at urethral meatus in trauma can be a sign of bladder/urethral injury

Blind placement of a Foley catheter can make an undiagnosed urethral injury worse

Urethral injury is evaluated using a retrograde urethrogram (RUG)

If urethra is confirmed to be intact, Foley catheter can be placed to allow additional tests

References:

Avery, L. (2012). Imaging of male pelvic trauma. Radiologic Clinics of North America., 50(6), 1201-1217.

Podcast #374: Iliac Artery Endofibrosis Sep 04, 2018

Show notes

Author: Sue Chilton, MD

Educational Pearls:

An unusual cause of leg pain that can mimic sciatica/claudication

Predominantly occurring in high endurance athletes, particularly cyclists and runners

More common in men

Check supine ABIs 1 minute after activity in the ED: a value

References:

Mansour A, Murney S, Jordan K, Laperna L. Endofibrosis: an unusual cause of leg pain in an athlete. J Sports Med Phys Fitness. 2016 Jan-Feb;56(1-2):157-61. Epub 2015 Jul 3. PubMed PMID: 26140352.

Peach G, Schep G, Palfreeman R, Beard JD, Thompson MM, Hinchliffe RJ. Endofibrosis and kinking of the iliac arteries in athletes: a systematic review. Eur J Vasc Endovasc Surg. 2012;43(2):208–17.

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