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 #281: Intracranial Hemorrhage Treatment Dec 15, 2017

Show notes

Podcast #281: Intracranial Hemorrhage Treatment

Author: Don Stader, M.D.

Educational Pearls

Types of traumatic bleeds include subdural, epidural, and subarachnoid.
Treatment for a traumatic bleed includes maintenance of systolic BP above 120 and seizure prophylaxis with phenytoin.
In atraumatic bleeds, treatment should focus on lowering blood pressure to reduce bleeding.

References: https://www.aliem.com/2017/09/intracranial-hemorrhage-management/

Podcast #280: Isolated Aphasia in Stroke Dec 11, 2017

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

Patients with an ischemic stroke from occlusion of the left middle cerebral artery often present with aphasia in addition to other neurological deficits.
A recent study looked at patients presenting with suspected stroke. Of the 700 patients recruited, 3% had isolated aphasia on exam. On follow-up, none of the 3% had evidence of stroke on imaging. Underlying causes of the isolated aphasia in these patients included syncope, infections, seizures were the underlying cause.

References: Gabriel Casella, Rafael H. Llinas, Elisabeth B. Marsh, Isolated aphasia in the emergency department: The likelihood of ischemia is low, Clinical Neurology and Neurosurgery, Volume 163, 2017, Pages 24-26, ISSN 0303-8467, https://doi.org/10.1016/j.clineuro.2017.10.013.

Podcast #279: Sedation After Intubation Dec 08, 2017

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

Post-intubation care should always include pain control and adequate sedation.
Commonly used sedation agents include propofol, ketamine and versed.
However, too much sedation is harmful. Deep sedation (RASS -4 to -5) is associated with worse long-term outcomes. RASS of 0 to -2 is ideal, as long as the patient is comfortable.

References: https://coreem.net/core/post-intubation/

Podcast #278: Subdural Hematomas Dec 06, 2017

Show notes

Educational Pearls

Subdural hematomas can happen in the elderly because of brain atrophy, and can manifest with neurological deficit.
Subdural hematomas are caused by rupture of the bridging veins of the brain. This can be caused by trauma, brain atrophy, or possibly by anticoagulant use. They are crescent-shaped on head CT.
Epidural hematomas, in contrast, are caused by rupture of meningeal arteries secondary to trauma. They are usually lens-shaped on head CT.
Subdurals are difficult to pick up on head CT because they may be isodense to brain tissue.

References: Management of Recurrent Subdural Hematomas Desai, Virendra R. et al. Neurosurgery Clinics , Volume 28 , Issue 2 , 279 - 286

Podcast #277: Mucor Dec 04, 2017

Show notes

Author: Don Stader, M.D.

Educational Pearls

Mucor/Rhizopus fungal infections usually present in diabetic or immunocompromised patients as a black, necrotic lesion on the face.
The fungus invades the vasculature of the face, causing tissue ischemia and necrosis.
The infection is more common in the diabetic population because the fungus prefers more acidic and glucose-rich environments.
This is a surgical emergency since it is cured only with excision of the affected tissue

References: Vijayabala GS, Annigeri RG, Sudarshan R. Mucormycosis in a diabetic ketoacidosis patient. Asian Pacific Journal of Tropical Biomedicine. 2013;3(10):830-833. doi:10.1016/S2221-1691(13)60164-1.

Podcast #276: Angioedema Dec 01, 2017

Show notes

Author: John Winkler, M.D.

Educational Pearls

Angioedema is immediately life-threatening due to airway obstruction.
Mechanisms include allergic reaction (histamine-related) or bradykinin-related (ACE-inhibitor, C1 esterase inhibitor deficiency).
The bradykinin-related mechanism will not respond to the traditional meds used for anaphylaxis. Instead, use FFP to replace depleted factors.
If a patient displays signs of respiratory compromise, intubation is indicated. Anesthesia should be consulted as this will be a very difficult airway.

References: https://emcrit.org/pulmcrit/treatment-of-acei-induced-angioedema/

Podcast #275: Battery Ingestions Nov 29, 2017

Show notes

Author: Nick Hatch, M.D.

Educational Pearls

Unlike coin ingestions, button batteries can cause necrosis of the GI tract.
If lodged in the esophagus, removal within 2 hours is important, because they can cause problems such as strictures or esophago-aortic fistula.
If the battery is in the stomach or beyond, it may be ok to let it pass but give strict return precautions.
Small hearing aid batteries are not as dangerous, but still require close follow-up to ensure the battery passes.
Delayed effects (after passage of the battery) are possible.

References: https://www.poison.org/battery/guideline

Podcast #274: Pediatric Sedation Nov 27, 2017

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

A recent prospective observational study was performed to examine the safety of different sedation medications in the pediatric ED.
This study included 6000 children, and looked at the rate of serious adverse events following administration of different sedatives.
Overall, the safest drug to use was ketamine alone, with an adverse event rate of about 1%.
Propofol, BZDs, and opiates had increased rates of adverse events.

References: https://lifeinthefastlane.com/pediatric-procedural-sedation-with-ketamine/

Podcast #273: Bag Valve Masks Nov 17, 2017

Show notes

Author: Sam Killian, M.D.

Educational Pearls

Difficulty with bag valve mask (BVM) ventilation can be addressed using the MOANS mnemonic.
Mask seal, Obesity/obstruction, Age, No teeth, Sleep apnea.
Often BVM difficulty can be addressed by an extra set of hands.

References: https://www.aliem.com/2012/10/mnemonics-for-difficult-airway/

Podcast #272: More on Temperature in Sepsis Nov 16, 2017

Show notes

Author: David Rosenberg, M.D.

Educational Pearls

A study of 20,000 subjects found that reducing fever in sepsis did not improve outcomes such as morbidity, mortality, or length of stay.
However, correcting fever may help for patient comfort.

References: Zhang Z, Chen L, Ni H. Antipyretic Therapy in Critically Ill Patients with Sepsis: An Interaction with Body Temperature. Azevedo LCP, ed. PLoS ONE. 2015;10(3):e0121919. doi:10.1371/journal.pone.0121919.

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected