Contributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing, and parasthesias Common causes of SVC syndrome include lung cancer, lymphoma, and thymoma Keep SVC syndrome on the differential for all patients with facial or upper extremity swelling References The superior vena cava syndrome: clinical characteristics and evolving etiology. Rice TW, Rodriguez RM...
Jan 14, 2020•5 min
Contributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids. The most effective agent in the cocktail is a dopaminergic agent Routine IV fluids have not shown efficacy There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl) Decadron reduces rebound headache Consider trigger point injections for those with migraine attributable to cervical neck pain. References...
Jan 13, 2020•3 min
Contributor: Don Stader, MD Educational Pearls: The common causes of anion gap metabolic acidosis include (MUDPILES) Metformin, Methanol Uremia DKA Paraldehyde INH/Iron Lactate Ethylene Glycol Salicylate Metformin is a very common drug used to treat type 2 diabetes, however in the right setting, it can cause a profound lactic acidosis. There is a very high mortality rate. Treatment of metformin toxicity includes fluids, bicarb, and dialysis Most commonly, metformin toxicity is in the setting of ...
Jan 08, 2020•5 min
Contributor: Aaron Lessen, MD Educational Pearls: Hemophilia is characterized by bleeding (A /B) A is is 8, B (chrstmas, 9) Hemophilia refers to a group of bleeding disorders caused by a deficiency in a certain clotting factor. The two most common are hemophilia A (caused by a lack of factor VIII), and B (caused by a lack of factor 9) Most cases are inherited in an X-linked recessive manner. Therefore, males are the most commonly affected. However, spontaneous cases do occur in all sexes. People...
Jan 08, 2020•3 min
Contributor: Michael Hunt, MD Educational Pearls: Cirrhosis is the end stage of chronic structural damage to the liver. This is most commonly due to alcohol but other causes viral hepatitis and hepatotoxic drugs Cirrhotic patients are very prone to GI bleeding and infections, partially due to the role the liver plays in producing immune and clotting factors These patients can easily become “sick”. Use the shock index (heart rate / systolic blood pressure) as a rapid assessment of hemodynamic sta...
Jan 06, 2020•5 min
Contributor : Erik Verzemnieks, MD Educational Pearls: Knee dislocations are most common in high energy trauma, such as a motor vehicle accident The knee may appear grossly normal on initial inspection since dislocations can spontaneously reduce - Look for such findings as hemarthrosis, instability, or ecchymosis, as clues to an occult dislocation. Knee dislocations are often associated with damage to the popliteal artery that runs behind the knee. Assess for pulse deficit on exam. If you are co...
Jan 03, 2020•2 min
Contributor: Charleen Melton, PharmD Educational Pearls: Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works by increasing the release of Von Willebrand factor, helping to stabilize clots. The use of DDAVP for intracranial hemorrhage in patients on antiplatelet agents (mainly Aspirin and Plavix) was recently reviewed In this retrospective review, they found an 88% decreased likelihood of hemorrhage expansion...
Dec 30, 2019•4 min
Contributor: Jared Scott, MD Educational Pearls: The ED is full of painful procedures. One of the most commonly dreaded procedures is nasal packing for epistaxis, as it is quite uncomfortable for the patient. A recent study compared TXA with compression, saline with compression, and traditional nasal packing for the treatment of epistaxis. Hemostasis was achieved in 91% with TXA and compression, 93% with nasal packing, and 71% with saline and compression. There was no statistically significant d...
Dec 24, 2019•3 min
Contributor: Sue Chilton, MD Educational Pearls: More intracardiac devices and injection drug abuse are thought to be increasing incidence of endocarditis Classic signs of endocarditis have included: Osler nodes (pain ful hemorrhagic lesions on hands and feet), Janeway lesions (pain less hemorrhagic lesions on the hands and feet), and splinter hemorrhages in the nail beds Other classic findings like fever and murmur are variable More non-specific symptoms can include flu-like symptoms Patients w...
Dec 20, 2019•4 min
Contributor: Don Stader, MD Educational Pearls: It can be difficult to distinguish between central and peripheral causes of vertigo. Cerebellar stroke should be considered with any dizzy patient. Signs and symptoms that suggest stroke as the cause of vertigo include: ataxia, cranial nerve deficits, and rapid onset of symptoms When cerebellar stroke is being considered, MRI is the imaging modality of choice since CT does not adequately visualize the posterior fossa. References Kim J, Lee H. Verti...
Dec 17, 2019•2 min
Husband and wife Pete and Katie Bakes, both emergency physicians in the Denver-Metro area, reflect on their upbringings, the many lessons learned over their twenty year careers, and how they've evolved as physicians and as a couple in this very special episode of UnfilterED. Time Stamps: 00:25 - Intros 03:05 - How did you two meet? 08:20 - (P) How have you seen Katie develop and change over the course of her medical career? 12:00 - (K) As a young woman, how did you balance your professional aspi...
Dec 14, 2019•1 hr 44 min
Contributor: John Winkler, MD Educational Pearls: Vaping-related lung injury initially presents with flu-like symptoms and can progress to respiratory failure requiring aggressive resuscitation including ECMO It is thought to be related to the contents of homemade vaping fluid, mostly in THC-containing products (“brands” include DankVapes, PaxPen) Ask patients with vague constitutional or respiratory symptoms about their vape use References What are the respiratory effects of e-cigarettes? Gotts...
Dec 10, 2019•3 min
Author: Jared Scott, MD Educational Pearls: A hyphema is blood in the anterior chamber of the eye, typically caused by trauma While there is a spectrum of disease, blurred vision and eye pain are common presenting complaints after direct trauma to the eye Hyphema are graded between Grade 1 and Grade 5, depending on the amount of blood in the anterior chamber. Higher grades are associated with worse outcomes and more complications Other important diagnoses to consider include globe rupture and re...
Dec 05, 2019•2 min
Contributor: Peter Bakes, MD Educational Pearls: Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical The differential for near cardiac arrest includes the “H’s and T’s”, just as in true cardiac arrest The 6 H’s include: hypoxia, hypo/hyperkalemia, hypovolemia (including shock states), hydrogen (acidosis), hypothermia The 6 T’s include: tension pneumothorax, cardiac tamponade, thrombus (PE/MI), toxins, trauma Use your history skil...
Dec 03, 2019•8 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Michael Miller, Strategic Initiatives Coordinator, Jefferson County Public Health
Nov 27, 2019•57 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Judith Shlay, MD, MSPH, Associate Director, Denver Public Health, and Brooke Bender, MPH, Center for Addiction Medicine Planner, Denver Health
Nov 27, 2019•45 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Christopher Urbina, MD, MPH, Colorado Consortium for Prescription Drug Abuse Prevention
Nov 27, 2019•1 hr 8 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Jason Vitello, MSW, Behavioral Health Coordinator, Denver Public Health/CPHA
Nov 27, 2019•53 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Sarah Davidon, EdD, Director of Research & Child and Adolescent Strategy, Mental Health Colorado, and Sarah Younggren, LCSW, Child & Adolescent Specialist, Mental Health Colorado
Nov 27, 2019•1 hr 6 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Carl Clark, MD , President & Chief Executive Officer, Mental Health Center of Denver
Nov 27, 2019•23 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Karen Prestia, MBA, Director, Marketing & Communications, Mental Health Center of Denver
Nov 27, 2019•33 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Allison Miller, LCSW, LAC, Program Manager of Child and Family Outpatient Services, Mental Health Center of Denver, and Jon Roberts, LCSW, CAC II, Licensed Mental Health Therapist, Mental Health Center of Denver
Nov 26, 2019•1 hr 11 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Tracy Vozar, Ph.D., Director of the Infant and Early Childhood Mental Health Specialty, and Jennifer M. Tippett, Psy.D., Director of the Substance Use Disorder Specialty, both at the University of Denver’s Graduate School for Professional Psychology
Nov 26, 2019•1 hr 6 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Marion Rorke, MPH, Substance Use Resource Coordinator, City and County of Denver, and Maggie Kauffman, MPH, Health Equity Data Analyst, City and County of Denver, and Jean Finn, RN, Substance Misuse Manager, City and County of Denver
Nov 26, 2019•32 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Lesley Brooks, MD, Chief Medical Officer, Sunrise Community Health Center; Medical Director – Quality, North Colorado Health Alliance, and Heather Ihrig, RN, CO-SLAW Program Director, North Colorado Health Alliance, and Meredith Silverstein, PhD, Sr. Research Associate, Butler Institute for Families, Graduate School of Social Work, University of Denver, and Kali Jefferson, MSW, Research Assistant, Butler Institute...
Nov 26, 2019•20 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Khara Croswaite Brindle, MA, LPC, ACS, Croswaite Counseling, PLLC
Nov 26, 2019•1 hr 13 min
From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Steven Wright, MD, Colorado Consortium for Prescription Drug Abuse Prevention
Nov 26, 2019•1 hr 51 min
Contributor: John Winkler Educational Pearls: There is increasing resistance to antimalarial drugs, especially in P. falciparum . This trend started with chloroquine, but is now spreading to the other first-line drugs. Resistant strains have been identified in Cambodia and Thailand 220 million people were infected last year The best treatment of malaria is prevention from bites - DEET and permethrin are typical effective options. Permethrin may be applied to clothing items before travel, and wil...
Nov 19, 2019•4 min
Contributor: Jared Scott, MD Educational Pearls In a 4 yr period at 2 hospital systems, unprofessional behavior of surgeons was monitored via a complaint system. Number of complaints was compared with surgical complications. In 13000 patients over this period, the number of surgical complications was found to vary with the number of complaints. Surgeons with with zero complaints had a 10% complication rate, 1-3 complaints had a 14% rate, and those with >4 and an 11.9% rate. There was statistical...
Nov 16, 2019•3 min
Contributor: Dylan Luyten, MD Educational Pearls: Bag-valve masks (BVM) typically have a port to connect O2 to. Unfortunately room air becomes entrained in the mask, reducing the FiO2 delivered to the patient. This can be overcome by using a PEEP (positive end-expiratory pressure) valve on the BMV PEEP valves function by keeping alveoli open in the lungs at the end of expiration. This increases the oxygen diffusing ability of the lungs, keeping patients’ oxygen saturations higher. Patients who a...
Nov 12, 2019•5 min
