Contributor: Don Stader, MD Educational Pearls: Gout is an arthritis caused by the deposition of urate crystals into the joint space Colchicine works by disrupting microtubules and prevents white blood cells from getting into the joint space which stops the inflammatory response Colchicine has a high rate of adverse events, in particular explosive diarrhea The drug also has a very narrow therapeutic index and overdose is nearly universally fatal, with no antidote or effective treatment option av...
Aug 10, 2020•4 min
Contributor: Jared Scott, MD Educational Pearls: Suicide is currently the 10 th leading cause of death in the US Low quality studies have reported ketamine as a potential promising agent in treating depression and preventing suicidal ideations or thoughts Randomized study was performed looking at giving ketamine to depressed patients in the ED to see if they could establish a proof of concept, meaning: would looking at ketamine for treatment of acute depression or suicidality be viable? 18 suici...
Aug 04, 2020•4 min
Contributor: Aaron Lessen, MD Educational Pearls: Hand raising test: a simple but effective tool to diagnose carpal tunnel Patients hold their hands over their head and if symptoms of carpal tunnel develop within 2 minutes, it is considered positive, meaning they likely have carpel tunnel Symptom included numbness and dull pain in the distribution of the median nerve Treatment for carpal tunnel in the ED can include splinting in a neutral position and oral steroids with possible follow up for st...
Aug 03, 2020•2 min
Meet Adis Keric, Board Certified Pharmacotherapy Specialist and a Board Certified Critical Care pharmacist who works in the Emergency Department and ICU of level 1 trauma center Regions Hospital in Saint Paul, MN. Adis is the founder and host of a new FOAMed podcast, ER-Rx. He started the podcast to inform clinicians in the ED and ICU about up-to-date, appropriate and optimal use of medications in different clinical scenarios. Dr. Nick Tsipis sits down with Adis to discuss some pearls in Emergen...
Jul 29, 2020•18 min
Contributor: Michael Hunt, MD Educational Pearls: Contrast agents are commonly used for X-rays and CT’s to better characterize disease, but contrast doesn’t work with MRI. That’s where the element Gadolinium comes into play. Gadolinium, element 64, is ferromagnetic (attracted to iron) below 68 degrees and above that temperature it’s paramagnetic which makes it useful in MRI ( Magnetic Resonance Imaging). Gadolinium is toxic alone, but when paired with chelators it can be used in humans and allow...
Jul 28, 2020•5 min
\Contributor: Don Stader, MD Educational Pearls: Altered mental status/confusion are major symptoms associated with both alcohol use and withdrawal. Wernicke’s encephalopathy is a triad of symptoms of confusion, internuclear ophthalmoplegia, and confabulation The treatment for Wernicke’s is IV thiamine or vitamin B1 Untreated Wernicke’s leads to Korsakoff's syndrome where a prolonged thiamine deficiency leads to worsening brain function Subdural hematomas from torn bridging veins are common in a...
Jul 27, 2020•6 min
Meet Michelle Whaley, Clinical Nurse Specialist and Stroke Program Coordinator at Sky Ridge Medical Center in Lone Tree, Colorado. Jordan and Michelle discuss advances in Artificial Intelligence technology in an app that uses algorithms to analyze CT Angiograms to alert physicians of patients with images concerning for Large Vessel Occlusions (LVOs). Listen as they discuss the sweeping implications of this technology in the realm of stroke care and how it is decreasing wait times for critical pa...
Jul 22, 2020•21 min
Contributor: Michael Hunt, MD Educational Pearls: PPE, or personal protective equipment, has become a major talking point since the emergence of the novel coronavirus (COVID 19). While ubiquitous now, there was not always equipment to protect health care providers or patients from infectious exposures. The invention of surgical gloves are credited to surgeon William Halsted. He developed gloves because one of his assistants (and later wife), Carol Hampton, was having severe irritation due to a c...
Jul 21, 2020•5 min
Contributor: Don Stader, MD Educational Pearls: Yersinia Pestis is the bacteria that caused the black plague. It was first discovered to be the cause of the bubonic plague in 1800s in China during the 3rd bubonic plague where 10-20 million people died Causes 3 types of plague: Bubonic plague: characterized by severe swelling of lymph nodes called buboes, most commonly in the groin, also axillary and olecranon lymph nodes. Septicemic plague: characterized by severe sepsis, no lymphadenopathy. Thi...
Jul 20, 2020•4 min
Author: Eric Miller, MD Educational Pearls: Brown-Sequard Syndrome is a neurological deficit that results from hemisection of the spinal cord This is usually from traumatic injury (blunt or penetrating), but can rarely be seen with cancer, disc herniation, or infection It presents with flaccid paralysis and loss of sensation to touch/vibration/position on the same side as the injury with loss of pain/temperature sensation on the opposite side of the injury. These deficits will be below the level...
Jul 14, 2020•2 min
Contributor: Don Stader, MD Educational Pearls: Checkpoint inhibition normally helps our body detect abnormal cells and terminate it but cancerous cells often are able to avoid this countermeasure Monoclonal antibodies that bind to checkpoint inhibitors can stop cancerous cells from turning off immunologic T cells and allows the immune system to continue to attack cancers. These therapies carry risks of exacerbating autoimmune problems due to the ramped up immune response Most often this autoimm...
Jul 13, 2020•6 min
Dr. Steven Bradley is an active duty U.S. Naval officer practicing as a Staff Anesthesiologist in Virginia where also resides on the Medical Ethics Committee for his hospital. He serves as the Anesthesiology Residency Simulation Coordinator there and enjoys the opportunity to teach residents drawing from his experiences as a student. He just recently started The Black Doctors Podcast where he strives to tell stories of Black physicians who overcame adversity to attain their goals so that young i...
Jul 08, 2020•39 min
Author: Charlene Gnisci Melton, PharmD Educational Pearls: Status Epilepticus is defined as continuous seizure activity for >5 minutes, or 2 or more seizures without full return to consciousness between events Status epilepticus is a true neurologic emergency with significant morbidity and mortality Aggressive, early treatment of status epilepticus is essential as GABA receptors will regress over time and make benzodiazepines less effective as time elapses Go large with doses of benzodiazepines ...
Jul 07, 2020•6 min
Contributor: Aaron Lessen, MD Educational Pearls: Studies have shown that patients who are under deeper sedation in the ICU have worse outcomes. Recent study compared lighter vs heavier sedation of patients in the emergency department receiving mechanical ventilation Patients receiving lighter sedation in the ED were often continued in the ICU Patients who had lighter sedation also tended to do better, meaning less days on the ventilator, less days in the ICU, and lower mortality supporting prio...
Jul 06, 2020•2 min
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In the fin...
Jul 06, 2020•48 min
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In this ep...
Jul 01, 2020•1 hr 2 min
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In this ep...
Jun 30, 2020•29 min
This limited series will investigate how the nation’s opioid epidemic has been impacted by the COVID-19 pandemic. Over the course of this series, we will hear from a harm reductionist, an addiction medicine physician, a Denver Police narcotics sergeant and two people currently in recovery. Unfortunately, both the opioid epidemic and the COVID-19 pandemic are likely not going anywhere soon. Emergency Medical Minute remains committed to providing education to help combat these health crises. In th...
Jun 29, 2020•41 min
Taken from 'UnfilterED #8: Dr. Christopher Hoyte'. “This current sars-coV-2 / COVID-19 situation should really be a wake-up call for not just a pandemic, but for a biological attack...One of the things I would like to do when we bring our attention back from COVID and get through this pandemic is to really start to prepare for disaster preparedness on the level and scale that we need to for a biological attack and get our hospitals ready, my poison center ready, state and local governments ready...
Jun 27, 2020•11 min
Dr. Chris Hoyte is an ED physician, toxicologist and researcher based in Denver, CO. He was featured in Bring Em’ All: Chaos. Care. Stories from Medicine’s Front Line , a book celebrating emergency physicians through personal testimonies and photography on the frontlines captured by legendary photographer, Eugene RIchards. Time Stamps: 01:25 - Dr. Hoyte’s Origin Story 05:01 - What Drew Dr. Hoyte to Medical Toxicology? 08:22 - Dr. Hoyte’s Most Interesting Toxicology Cases 08:52 - King Cobra Bite ...
Jun 24, 2020•47 min
Contributor: Nick Tsipis, MD Educational Pearls: Significant cyanide exposure most commonly occurs from fire/smoke exposure particularly when plastics are involved Cyanide binds to cytochrome oxidase leading to the use of anaerobic metabolism which causes a profound lactic acidosis Classic toxicity includes a rapid loss of consciousness, hypotension, bradycardia, respiratory depression, and seizures Mild exposures can lead to nausea/vomiting, headaches, and other nonspecific symptoms. Sometimes ...
Jun 23, 2020•6 min
Contributor: Nick Tsipis, MD Educational Pearls: Arsenic is a heavy metal that binds to multiple cellular enzymes and inhibits aerobic metabolism It is primarily absorbed through the skin, respiratory and GI tract. The classic symptoms of heavy metal exposure are GI irritation (watery diarrhea, vomiting and abdominal pain) with multisystem organ failure. Neuropathy can present insidiously Initial work up includes EKG, and basic lab work (expect a delayed rise in liver function tests). Acute arse...
Jun 22, 2020•5 min
In addition to producing our own content, we believe in using our platform to amplify other voices and perspectives in medicine. With that in mind, check out 'The Black Doctor Podcast' from Dr. Steven Bradley which features interviews with leading minority professionals of the current generation as well as stories of how they overcame adversity and attained their goals. "Listen and be inspired." Podcasts available on Apple Podcasts , Spotify and all other major streaming platforms Twitter: @Stev...
Jun 21, 2020•30 sec
Contributor: Aaron Lessen, MD Educational Pearls: Locked in syndrome results typically from an infarct of the basilar artery leading to infarction of the brainstem but typically preservation of the higher structures The result is complete paralysis with preserved cognitive function, hence the name Because of their location within the brainstem, ocular movements are sometimes preserved, allowing a patient who recovers from the initial injury to communicate Patients typically do not regain any mot...
Jun 16, 2020•3 min
Contributor: Jared Scott, MD Educational Pearls: Traditional digital block involves dorsal approach on either side of the digit, injecting local anesthetic along each side to numb all four nerves of the digit Newer approach involves a single injection along the palmar surface at MCP joint Recent study further compared a proximal vs distal single palmar (volar) injection with sites at the MCP and PIP joints Injection sites achieved similar anesthesia between groups but PIP injection site had fast...
Jun 15, 2020•4 min
Contributor: Aaron Lessen, MD Educational Pearls: Supplemental oxygen is not a completely benign intervention. A recent meta-analysis found that O2 saturations above 96% while on supplemental O2 were associated with worse outcomes. Only start a patient on supplemental oxygen if absolutely necessary and aim for a goal of no higher than 96% References Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Schünemann, John D Neary, Wale...
Jun 09, 2020•2 min
Contributor: Aaron Lessen, MD Educational Pearls: . Focused assessment with Sonography for Trauma (FAST) exam and the extended-FAST (eFAST) are essential components of current trauma care and evaluation There has been an accumulation of research to provide an estimate of effectiveness of identifying certain injuries with ultrasound: For identifying a pneumothorax, the sensitivity ~70% and specificity ~99%. For pericardial effusions, sensitivity 90% and specificity ~ 94%. For hemoperitoneum, sens...
Jun 08, 2020•2 min
Contributor: John Winkler, MD Educational Pearls: Unstable ventricular tachycardia (VT) typically manifests with syncope, shortness of breath, diaphoresis and/or chest pain with hemodynamic instability Electrical cardioversion of unstable ventricular tachycardia is first line treatment Starting with a higher energy level (or just using the maximum) when performing cardioversion may set you up for better success as many providers feel the first shock has the highest likelihood of success Referenc...
Jun 02, 2020•3 min
Contributor: Aaron Lessen, MD Educational Pearls: Mechanical CPR (machine assisted compression devices) remains a hot topic of debate in emergency medicine Machine assisted CPR has been advocated to provide more consistent compressions in cardiac arrest and free up staff for other tasks. However, multiple studies have shown mechanical CPR provides no significant survival benefit yet increased rates of injury to the chest and abdomen from the devices. Unless a clear benefit can be found, mechanic...
Jun 01, 2020•3 min
"Go unafraid! And also know that you got to reach out to the right people and hold on to those people no matter what they look like, no matter what background they come from...Find people who are positive in your life who can help you. If I'm one of those people, reach out to me." Russell J. Ledet hails from Lake Charles, Louisiana. After serving in the U.S. Navy, he attended Southern University and A&M College for his undergraduate degrees in biology and chemistry. Afterwards, he went on to com...
May 31, 2020•5 min
