Emergency Medical Minute

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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:

Brewcast Part I: The History of Cannabis in Medicine Jul 02, 2017

Show notes

Author: Don Stader, M.D

Topic: Don kicks things off with an overview of the history of marijuana and how it has made its way into medicine.

Podcast #224: Troponin Jul 01, 2017

Show notes

Author: Sam Killian, M.D.

Educational Pearls

Not every troponin elevation is an MI.
Trop elevates in about an hour in ACS and stays elevated for days.
Non-MI conditions that cause elevated troponin: Critical illness (sepsis), increased cardiac demand, right heart strain, LV dysfunction, hypotension, pressor use, acute PE, SAH, chronic renal failure, CHF, aortic dissection, and peri/myocarditis.
Elevated troponin in settings other than MI is correlated with increased mortality.

References: Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006;92(7):987-993. doi:10.1136/hrt.2005.071282.

Podcast #223: Acyclovir Toxicity Jun 29, 2017

Show notes

Author: Nick Hatch, M.D.

Educational Pearls

Acyclovir toxicity can uncommonly cause altered mental status, low blood glucose, hallucinations and myoclonic jerks.
Toxicity often occurs in the setting of renal insufficiency, as it is cleared by the kidneys.
Acyclovir is often used to treat shingles, which can also cause similar symptoms as acyclovir toxicity due to encephalitis - rule this out in the setting of a concomitant shingles infection.

References: http://www.rxlist.com/zovirax-drug.htm

Podcast #222: Wells Criteria for PE Jun 27, 2017

Show notes

Author: Michael Hunt, M.D.

Educational Pearls

Wells Criteria was initially designed to screen patients for further workup for PE.
Aspects of the Wells Criteria include: signs and symptoms of DVT (3 points), PE most likely dia (3 points), HR > 100 (1.5 points), immobility for > 3 days or surgery in last 4 weeks (1.5 points), documented history of PE (1.5), hemoptysis (1), treatment for cancer in last 6 mo (1).
ACEP uses a score of less than or equal to 4 to define "low risk." Greater than 4 is "high risk".
Use Wells to guide clinical decisions about PE workup.

References: http://www.ebmedicine.net/media_library/files/1212%20Pulmonary%20Embolism

Podcast #221: Walking Corpse Syndrome Jun 25, 2017

Show notes

Podcast #221: Walking Corpse Syndrome

Author: Erik Verzemnieks, M.D.

Educational Pearls

Walking Corpse Syndrome (aka Cotard Delusion) is a very rare psychiatric disorder that leads to the belief that one is a "walking corpse".
Often co-presents with depression, schizophrenia, and starvation.
Responds to ECT.

References: https://en.wikipedia.org/wiki/Cotard_delusion

Podcast #220: A-Fib Cardioversion Jun 23, 2017

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

Atrial fibrillation is common.
One of the best treatments for a fib is cardioversion back into sinus rhythm.
Cardioversion may increase stroke risk if A-Fib duration is greater than 48 hours, but some new data suggests that this risk may happen as soon as 12 hours.
However, newer studies show that cardioversion is generally safe as a treatment for A-Fib.

References: Aatish Garg, Monica Khunger, Sinziana Seicean, Mina K. Chung, Patrick J.Tchou Incidence of Thromboembolic Complications Within 30 Days of Electrical Cardioversion Performed Within 48 Hours of Atrial Fibrillation Onset. JACC: Clinical Electrophysiology Aug 2016, 2 (4) 487-494; DOI: 10.1016/j.jacep.2016.01.018

Podcast #219: History of Sepsis Jun 21, 2017

Show notes

Author: Chris Holmes, M.D.

Educational Pearls

"Sepo' is a term from Homer (author of The Iliad and The Odyssey), and means "I rot".
Hippocrates in 400 BC identified sepsis as a "dangerous decay within the body".
Galen in 200 AD believed pus was "laudable".
The Greeks and Romans used the term "myasma" to describe the smell of swamp and rotting flesh.
Dr. Emmanuel Rivers in Detroit did one of the the first big studies about sepsis and was an advocate for goal-directed therapy.
Now, Vitamin C cocktails are in use, but new sepsis treatments should be investigated carefully before implementation.

References: Funk, Duane J. et al. Sepsis and Septic Shock: A History. Critical Care Clinics , Volume 25 , Issue 1 , 83 - 101

Podcast #218: Estimating Pediatric Weight Jun 19, 2017

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls

Asking parents and Broselow Tape are common options for estimating pediatric weight.
Equipment sizes should not be adjusted for under/overweight kids based on Broselow Tape estimates.
The finger counting method (see reference) is just as accurate as Broselow Tape method, according to one study.

References: http://handtevy.com/images/Casestudies/Americanjournalofemergencymedicine.pdf

Podcast #217: Designer Drugs Jun 17, 2017

Show notes

Author: John Winkler, M.D.

Educational Pearls:

Designer, or "synthetic" drugs include bath salts, synthetic THC, and many others.
Many of these drugs are originally manufactured in China and are shipped globally.
Treatment usually involves airway control and sedation - ketamine may be useful.
Traditional tox screens do not test for these drugs.

References: https://www.drugabuse.gov/related-topics/trends-statistics/national-drug-early-warning-system-ndews

Podcast #216: Roller Coasters and Kidney Stones Jun 13, 2017

Show notes

Author: Aaron Lessen, M.D.

Educational Pearls:

Anecdotal evidence suggests that roller coasters may help with kidney stones.
A recent study used a model of a kidney and ureter with different sized stones and put it on Thunder Mountain roller coaster in Disney World.
There was "dramatic passage" of the kidney stones at the rear of the roller coaster.

References: Marc A. Mitchell, DO; David D. Wartinger, DO, JD. Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster. The Journal of the American Osteopathic Association, October 2016, Vol. 116, 647-652. doi:10.7556/jaoa.2016.128. http://jaoa.org/article.aspx?articleid=2557373

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