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 #245: Hypoglycemia Aug 29, 2017

Show notes

Author: Dylan Luyten, M.D.

Educational Pearls

Hypoglycemia is very common in type 2 diabetics, and is often caused by insulin overdose or missed meals. Knowing the peak time of action for common diabetes medications can help inform treatment and disposition.
Regular insulin's action peaks around 60 minutes. By the time most of these patients present to the ED, the drug has had most of its effect.
Lantis' action does not peak, and will continue to exert its effect for 12 or more hours.
Levamir has a peak around 6-8 hours.
Metformin sensitizes tissues to insulin, so it cannot cause hypoglycemia alone.
Glipizides have half-lives over 12 hours and work by increasing insulin release by the pancreas. Hypoglycemia in a patient taking a glipizide usually indicates there is another medical issue interfering with clearance

References: http://emedicine.medscape.com/article/122122-workup

Podcast #244: Clavicle Fracture Review Aug 27, 2017

Show notes

Author: Nick Hatch, M.D.

Educational Pearls

The force required to break a clavicle is significant, so clavicle fracture may be associated with other injury (pneumothorax, vascular injury).
Most fractures occur in the middle 1/3 of the clavicle.
Traditionally, clavicle fractures have been managed without surgery. However, recent studies have shown that surgery may be beneficial in a larger population than previously thought.

References: http://emedicine.medscape.com/article/398799-overview

Podcast #243: Sphenopalatine Nerve Block Aug 25, 2017

Show notes

Author: Don Stader, M.D.

Educational Pearls

Cluster headaches are usually intense, unilateral, and involve the periorbital area.
CN V (Trigeminal) provides sensory and autonomic innervation the face and eyes, which play roles in headache pathology.
Cluster headaches can be treated with high flow oxygen, but a new treatment involves blocking the sphenopalatine ganglion (SPG) with lidocaine. Because sensory and autonomic branches of the trigeminal traverse the SPG, lidocaine will effectively treat a cluster headache.
To block the ganglion, intranasal lidocaine may be used, or a Q-tip soaked in 4% lidocaine can be applied to the most posterior aspect of the pharynx for 10-15 minutes.

References: https://www.aliem.com/2017/03/trick-sphenopalatine-ganglion-block-primary-headaches/

Podcast #242: Pott's Puffy Tumor Aug 23, 2017

Show notes

Author: Suzanne Chilton, M.D.

Educational Pearls

Pott's puffy tumor is a subperiosteal abscess of the frontal bone that arises from hematologic spread or direct infection via the frontal sinuses. The primary symptom is facial swelling.
It is much more common in children and adolescents.
Treatment involves removal of the frontal bone, reconstructive surgery, and 6-8 weeks of IV antibiotics.

References: Grewal HS, Dangaych NS, Esposito A. A tumor that is not a tumor but it sure can kill! The American Journal of Case Reports. 2012;13:133-136. doi:10.12659/AJCR.883236.

Podcast #241: GERD vs. MI Aug 21, 2017

Show notes

Author: Dave Rosenberg, M.D.

Educational Pearls

MI and GERD can present similarly. For example, 47% with angina report increased belching with an anginal attack, and 20% of people with an MI describe symptoms of indigestion that are relieved by antacids.
Overall, GERD is more common in those with CAD, so don't be "reassured" by GERD symptoms in the setting of chest pain.

References: http://www.mdedge.com/ecardiologynews/article/82215/cad-atherosclerosis/gerd-may-boost-risk-mi

Podcast #240: Honey and Burns Aug 19, 2017

Show notes

Podcast #240: Honey and Burns

Author: Nick Hatch, M.D.

Educational Pearls

Honey can be used to treat burns because it has antibacterial properties. In one study, honey outperformed silver sulfadiazine for burn treatment, but more research is needed in this area.
In practice, honey is likely more useful outside the ER than inside the ER.

References: Gupta SS, Singh O, Bhagel PS, Moses S, Shukla S, Mathur RK. Honey Dressing Versus Silver Sulfadiazene Dressing for Wound Healing in Burn Patients: A Retrospective Study. Journal of Cutaneous and Aesthetic Surgery. 2011;4(3):183-187. doi:10.4103/0974-2077.91249.

Podcast #239: Tetanus in the ED Aug 17, 2017

Show notes

Author: Rachel Beham, PharmD, Advanced Clinical Pharmacist - Emergency Medicine

Educational Pearls

Tetanus Ig is indicated in those who have no or unknown tetanus vaccination history who present with contaminated cuts that or dirty puncture wounds
The tetanus vaccine is a 5 shot series (DTAP) for children, TDAP is used for adults
There is no harm is receiving the TDAP more than once if vaccination history is unknown

References: https://www.cdc.gov/features/tetanus/index.html

Podcast #238: Ultrasound in Cardiac Arrest Aug 15, 2017

Show notes

Author: Aaron Lessen M.D.

Educational Pearls

Ultrasound is helpful in the setting of cardiac arrest for finding a cause like cardiac tamponade or PE, but also for predicting outcomes for non-shockable rhythms.
One study showed that in those that presented with asystole or PEA and cardiac activity on US had a 4% survival rate, while those without cardiac activity had almost no chance.

References: Philip Salen, Larry Melniker, Carolyn Chooljian, John S. Rose, Janet Alteveer, James Reed, Michael Heller, Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients?, The American Journal of Emergency Medicine, Volume 23, Issue 4, 2005, Pages 459-462, ISSN 0735-6757, http://dx.doi.org/10.1016/j.ajem.2004.11.007.

Deep Dive #5: The Evolution of Sepsis Treatment Aug 11, 2017

Show notes

Author: Susan Brion, M.D.

Dr. Brion enlightens us on the ever-evolving standard of sepsis management.

Podcast #237: Phimosis vs. Paraphimosis Aug 09, 2017

Show notes

Author: Sam Killian, M.D.

Educational Pearls

Phimosis refers to the inability to retract the distal foreskin over the glans penis in uncircumcised males. Paraphimosis is the entrapment of the foreskin proximal to the glans penis in these patients.
Phimosis is rarely a medical emergency, but requires follow up with urology. Paraphimosis, on the other hand, can cause venous and lymphatic insufficiency, leading to infarction, necrosis and autoamputation. Therefore, paraphimosis requires emergent treatment with manual reduction of the foreskin or surgery.

References:

Aaron Vunda, M.D., Laurence E. Lacroix, M.D., Franck Schneider, Sergio Manzano, M.D., and Alain Gervaix, M.D. Reduction of Paraphimosis in Boys. N Engl J Med 2013; 368:e16

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