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 #290: The Biochemistry of DKA Jan 12, 2018

Show notes

Author: Dave Rosenberg, M.D.

Educational Pearls

DKA commonly causes hyperkalemia, leading to peaked T-waves on ECG. However, DKA causes hypokalemia at the same time.
In DKA, glucose cannot be taken into the cells. This signals the body to create and use acidic ketones for energy. This leads to acidosis. To compensate for increased acid, H ions are pumped into cells. To maintain electroneutrality, K is pumped out of the cell. At the kidney, K is lost in the urine.
Overall, while serum K is high in DKA, total body K is low. The derangement in K can lead to life-threatening arrhythmias.
Treatment for DKA can induce hypokalemia, as the K will shift back into the cells with insulin administration. Therefore, treatment for DKA needs to include K.

References: http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka

Podcast #289: Cannabinoid Hyperemesis Jan 10, 2018

Show notes

Author: Dylan Luyten, M.D.

Educational Pearls

Cannabinoid Hyperemesis syndrome is a relatively new diagnosis that presents with vomiting and abdominal pain without a clear etiology in the setting of daily marijuana use.
The pathophysiology is not well-understood well, but may involve cannabinoid receptors in the gut.
Treatment is abstinence from marijuana, fluids, dextrose, and antiemetics (haldol, ondansetron, etc). Opioids should be avoided.
Capsaicin cream on the abdomen may be helpful, as it can distract from the pain and vomiting. Milk can be used to reverse its effects.

References: Galli JA, Sawaya RA, Friedenberg FK. Cannabinoid Hyperemesis Syndrome. Current drug abuse reviews. 2011;4(4):241-249.

Podcast #288: Diarrhea Jan 08, 2018

Show notes

Author: Peter Bakes, M.D.

Educational Pearls

Chronic diarrhea is defined as 3 or more loose, watery stools lasting more than 2-3 weeks.
Look for clues in the history, including travel (could suggest infectious etiology), antibiotic use (could suggest C. Diff), and family history.
Irritable Bowel Disease (Crohn's/Ulcerative Colitis) is an autoimmune disorder that affects 1.3 million Americans and is a leading cause of chronic diarrhea.
Crohn's always involves the terminal ileum, but can present anywhere along the GI tract. It causes transmural inflammation of the bowel wall and can lead to adhesions, perforations, and fistulas. Ulcerative colitis usually involves the rectum and causes mucosal inflammation only.
Workup for IBD includes colonoscopy and tissue biopsy.
Treatment for IBD includes dietary changes, 5-ASA/Mesalamine, steroids, and infliximab (anti-TNF alpha).

References: https://www.aafp.org/afp/2011/1115/p1119.html

Podcast #287: Sepsis Bundles Jan 05, 2018

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

Treatment "bundles" are a popular approach to the rapid resuscitation of septic patients. A recent study in New York, where sepsis bundles are mandatory, sought to figure out which aspects of the bundle had impacts on mortality.
In a study of 40,000 septic patients, the study found that early antibiotics were associated with better outcomes, while early IV fluids were not associated with better outcomes.
This study affirms the important role of early antibiotics in sepsis. IV fluids may play an important role in the treatment of sepsis in some patients, but its role is less clear than antibiotics.

References: Time to Treatment and Mortality during Mandated Emergency Care for Sepsis Christopher W. Seymour, M.D., Foster Gesten, M.D., Hallie C. Prescott, M.D., Marcus E. Friedrich, M.D., Theodore J. Iwashyna, M.D., Ph.D., Gary S. Phillips, M.A.S., Stanley Lemeshow, Ph.D., Tiffany Osborn, M.D., M.P.H., Kathleen M. Terry, Ph.D., and Mitchell M. Levy, M.D. N Engl J Med 2017; 376:2235-2244 June 8, 2017 DOI: 10.1056/NEJMoa1703058

Podcast #286: Coronary Vascular Conditions that aren't STEMI Jan 03, 2018

Show notes

Author: Don Stader, M.D.

Educational Pearls

While we usually associate the coronary vasculature with STEMIs, there are other pathologies that can affect the heart's blood supply.
Kounis syndrome: an allergic vasospasm of the coronary arteries. This can happen post anaphylaxis or be caused by a stent allergy. It is best treated with aggressive management of the allergic reaction.
Kawasaki disease: An autoimmune condition that presents in kids as conjunctivitis, lymphadenopathy, hand/foot swelling, rash, and fever. It can also cause coronary aneurysms, which can rupture and be rapidly fatal.
Prinzmetal angina: Caused by coronary vasospasm. Presents with transient chest pain at rest. Treat with CCBs.
Cocaine: Causes coronary vasospasm. Cocaine-induced vasospasm is best treated with BZDs.
Coronary artery dissection: increased risk in pregnant women and those with connective tissue disorders.

References: Memon S, Chhabra L, Masrur S, Parker MW. Allergic acute coronary syndrome (Kounis syndrome). Proceedings (Baylor University Medical Center). 2015;28(3):358-362.

Podcast #285: C Diff Jan 01, 2018

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

While C. difficile infections are generally thought of as nosocomial, there is a subset of patients who acquire the infection in the community.
One recent study showed that about 10% of patients presenting to the ED with diarrhea and without vomiting had a C. diff infection.
Another study found risk factors for community-acquired C. diff included recent ED/Urgent care visits and antibiotic use. However, 36% of the patients in that study had no identifiable risk factors.

References: Gupta A, Khanna S. Community-acquired Clostridium difficile infection: an increasing public health threat. Infection and Drug Resistance. 2014;7:63-72. doi:10.2147/IDR.S46780.

Podcast #284: Plane Emergencies Dec 29, 2017

Show notes

Author: Erik Verzemneicks, M.D.

Educational Pearls

1/600 flights has an on-board request for medical assistance.
Most common complaints on board include: syncope, respiratory complaints, and GI complaints. Most of the time, these are exacerbations of underlying chronic conditions.
Except for situations involving gross negligence, the Aviation Assistance Act protects providers from legal action as long as they are acting within their scope of practice.
Flight crew are CPR and AED trained.
The onboard medical kit includes: epinephrine, dextrose, nitroglycerin, NSAIDs, injectable antihistamine, antiemetic, steroids, beta-blocker, aspirin, stethoscope, BP cuff, airway tools, thermometer and more.
There is ground-based medical control for consult and guidance.

References: https://www.acep.org/Clinical---Practice-Management/Emergency-at-30,000-Feet---What-You-Can-Do/#sm.0001eqpidqrpoczltzg1epg0m0aqu

Podcast #283: Snow Blindness Dec 27, 2017

Show notes

Author: John Winkler, M.D.

Educational Pearls

Photokeratitis is a UV burn of the sclera and cornea, which can cause blindness.
UV light causes eyelid swelling with diffuse scarring of the eye (widespread, punctate uptake of fluorescein dye). While this can eventually heal, it is incredibly painful.
Snow reflects light underneath sunglasses, so wrap-around goggles are the best form of prevention.
This can happen to welders, sunbathers or any other person with prolonged UV light exposure.

References: https://emedicine.medscape.com/article/799025-treatment

Podcast #282: EKG Changes in DKA Dec 25, 2017

Show notes

Author: Dave Rosenberg, M.D.

Educational Pearls

EKG changes that can be seen in DKA include ST elevation and peaked T-waves secondary to derangements in K levels.
In DKA, serum K is high, but total body K is low, which can cause said EKG abnormalities.
Many things cause ST elevation besides MI, so think beyond STEMI.
When someone in in DKA, think about the "Three I's" for underlying cause: (not taking) insulin, ischemia, infection.

References: Nageswara Rao Chava. ECG in Diabetic Ketoacidosis. Arch Intern Med. 1984;144(12):2379–2380. doi:10.1001/archinte.1984.00350220101022

Deep Dive #8: Wintertime Wilderness Medicine Dec 18, 2017

Show notes

Author: John Winkler, M.D.

Dr. Winkler shares his knowledge of wilderness medicine and provides insight on how to prevent and treat conditions such as hypothermia, frostbite and sun blindness. More importantly, he gives us tips on how to stay safe while doing our favorite wintertime activities!

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected