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...
Aug 21, 2017•4 min
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 ...
Aug 19, 2017•3 min
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...
Aug 17, 2017•3 min
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 He...
Aug 15, 2017•2 min
Author: Susan Brion, M.D. Dr. Brion enlightens us on the ever-evolving standard of sepsis management.
Aug 11, 2017•22 min
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 tr...
Aug 09, 2017•4 min
Author: Nick Hatch, M.D. Educational Pearls When peripheral or central IV access is difficult, sometimes providers will try to use a peripheral IV setup at an IJ site using US guidance. Case studies have shown that this method is often successful, with the most common complication being the loss of access. References: Ash AJ, Raio C. Seldinger Technique for Placement of “Peripheral” Internal Jugular Line: Novel Approach for Emergent Vascular Access. Western Journal of Emergency Medicine . 2016;1...
Aug 07, 2017•4 min
Author: Pete Bakes, M.D. Educational Pearls One of the roles of the ER provider is to discharge patients only after life-threatening conditions have been ruled out. However, some patients that are discharged from the ED die within days of their discharge. One recent study sought to investigate the factors and diagnoses associated with death within 7 days of discharge. This study was a retrospective study in 10 million medicare recipients that presented to the ER over 10 years. They excluded pall...
Aug 05, 2017•7 min
Author: Dylan Luyten, M.D. Educational Pearls Around 30% of patients in the ER receive CT imaging, and the sensitivity of CT imaging may be improved with IV contrast. However, contrast is often withheld for fear of contrast-induced nephropathy. A recent, single-center, retrospective cohort study compared the rates of nephropathy between contrast CT, non-contrast CT, and no CT control patients, and found no differences. This study confirms what many have believed to be true - that the dangers of ...
Aug 03, 2017•3 min
Author: Don Stader, M.D. and Rachael Duncan, PharmD BCPS BCCCP Educational Pearls Carfentanil is an opioid elephant tranquilizer that can be used recreationally. It is 1000 times stronger than fentanyl, and looks like a white powder. Healthcare workers must be cautious when carfentanil overdose is suspected, as the drug can be absorbed through caregivers’ skin if it is present on the patient’s clothes. Overdose may require large amounts of naloxone, and a drip may be started at a rate equivalent...
Aug 01, 2017•5 min
Author: Gretchen Hinson, M.D. Educational Pearls High-Altitude Pulmonary Edema (HAPE) is caused when hypoxemia due to low ambient pO2 leads to breakdown and constriction of the pulmonary vasculature leading to edema. HAPE is very rare under 8000 ft, but common over 10000 ft (6%). Over 18,000 ft the incidence is very high (12-15%). Symptoms include dyspnea, cough, weakness and chest tightness. Signs include hypoxemia, crackles, wheezing, central cyanosis, tachypnea and tachycardia. Drugs that red...
Jul 30, 2017•6 min
Author: Jared Scott, M.D. Educational Pearls Boerhaave syndrome (aka effort rupture of the esophagus) accounts for 10% of esophageal ruptures and is usually caused by strain during vomiting episodes. It can also be caused by childbirth, seizure, or prolonged coughing or laughing. Food and water swallowed after the tear end up in the mediastinum, eventually causing infection. Therefore, Boerhaave syndrome is a surgical emergency. Best diagnostic techniques are CT or endoscopy. Mallory-Weiss syndr...
Jul 28, 2017•5 min
Author: Aaron Lessen, M.D. Educational Pearls 2 studies this past year looked at pediatric and adolescent patients following a concussion. They found people who returned to activity sooner did better than those who went on “brain rest”. While patients should still follow up with their PCP following a concussion, it is ok for patients to return to physical activity as tolerated. References: Grool AM, Aglipay M, Momoli F, Meehan WP, Freedman SB, Yeates KO, Gravel J, Gagnon I, Boutis K, Meeuwisse W...
Jul 26, 2017•2 min
Author: Sam Killian, M.D. Educational Pearls Andrew Jackson was the 7th president of the USA. He served 2 terms from 1829-1837. He had had many medical issues during his presidency. He was said to be chronically underweight with rotting teeth. Furthermore, he had chronic infections and lead poisoning from bullets lodged in his arm and chest. He suffered from smallpox that he contracted while in a British prison during the Revolutionary War. He died from “dropsy” (CHF). References: http://www.doc...
Jul 24, 2017•6 min
Author: Jared Scott, M.D. Educational Pearls BB gun eye injuries are most common in August and September. They most often happen to males aged 16-17 year old. Around 10% of the BB eye injuries lead to eye loss. Accidental firearm injury is common in children and is a common cause of mortality. One-third of homes with children have a firearm. Most accidental pediatric gun injuries happen to young, male children with guns owned by family members. It is important to educate gun owners about proper ...
Jul 22, 2017•4 min
Author: Nick Hatch, M.D. Educational Pearls CPR-induced consciousness is a phenomenon that occurs when someone who was previously unconscious and is undergoing CPR regains consciousness and makes purposeful movements. Studies have shown that this phenomenon is increasing, likely because of increased quality of CPR. Many people use a sedative such as ketamine to keep patients unconscious to reduce the psychologic trauma of CPR. 39% of people who survive CPR with good neurologic details remember t...
Jul 20, 2017•4 min
Author: Sam Killian, M.D. Educational Pearls Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours. Biphasic happens in patients that have a complete resolution of their anaphylaxis for at least an hour, but then have a recurrence that requires pharmacologic intervention. Most of the time this happens 3-6 hours later, but can happen more than 10 hours later. More commonly happens in patients that have a delayed presentation, a wide pulse pressure, nee...
Jul 18, 2017•3 min
Author: Dylan Luyten, M.D. Educational Pearls Rhogam is commonly used when an Rh negative woman has an Rh positive fetus. It is commonly used in the ER in the setting of a miscarriage. Rh(+) fetal blood can enter the Rh(-) maternal circulation, sensitizing the woman to the Rh antigen. During a subsequent pregnancy, if the fetus is Rh(+), the woman may mount an immune response to the fetus, lead to fetal demise. Rhogam is used to block this process. Use of Rhogam has reduced this complication fro...
Jul 16, 2017•4 min
Author: Justin Harper Justin Harper, a paramedic married to a pediatric nurse, discovered his own son had type I diabetes 2 years ago. Despite their medical experience, this diagnosis came as surprise to Justin and his wife. This is the compelling story about how their son was diagnosed with type I diabetes and how this has impacted their lives.
Jul 14, 2017•47 min
Author: Dr. Larry Wolk, Executive Director and Chief Medical Officer for the Colorado Department of Public Health and Environment. Topic: Dr. Larry Wolk educates us on how cannabis has affected Colorado since medical and recreational legalization.
Jul 09, 2017•18 min
Authors: Don Stader, M.D. & Lauren Gibbs Topic: Lauren breaks the stoner stereotype and explains how marijuana has positively impacted her life.
Jul 08, 2017•20 min
Author: Erik Verzemnieks, M.D. Topic: Erik speaks about how slightly altering the chemical composition of marijuana can create a drug with drastic effects on the human body. WARNING: Explicit Language
Jul 07, 2017•12 min
Author: Sophie Yorkwilliams -B.A. (Psychology) -Dual Ph.D. Candidate, Clinical Psychology and Neuroscience. Expected graduation: 2020 Topic: Studying cannabis comes with its own set of challenges. Find out how Sophie and her team have overcome obstacles to get accurate data on marijuana.
Jul 06, 2017•18 min
Authors: Don Stader, M.D. & Peter Pryor, M.D. Topic: What caused Dr. Pryor to leave emergency medicine and enter the realm of medical marijuana?
Jul 05, 2017•24 min
Author: Rachael Duncan, PharmD BCPS BCCCP Topic: Rachel explains the science behind one of the most common maladies thought to be induced by chronic cannabis use.
Jul 04, 2017•15 min
Author: Brett Marlin, M.D. Topics: Brett explains the biochemical and physiological properties of cannabis.
Jul 03, 2017•19 min
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.
Jul 02, 2017•21 min
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 ...
Jul 01, 2017•4 min
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...
Jun 29, 2017•3 min
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 “h...
Jun 27, 2017•5 min
